Electrophysiological Outcome Measures in Spinal Cord Injury Clinical Trials: A Systematic Review

Korupolu, Radha; Stampas, Argyrios; Singh, Mani; Zhou, Ping; Francisco, Gerard E.

doi:10.1310/sci2504-340

Cited by 15 publications

(8 citation statements)

References 73 publications

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“…Hence, the algorithms with a much lower electrical and magnetic stimulation intensity than those used by other researchers (see Table 4 and Table 5 ) and the use of surface electromyography (sEMG) instead of invasive needle electromyography for evaluation of the treatment results were considered. For diagnostic purposes, sEMG is contemporarily considered a functional test precise and specific enough to evaluate the entire efferent transmission from the supraspinal level to the muscles in iSCI patients treated with the different classical conservative methods as well as the newest based on the neuromodulation [ 38 , 39 ]. Nevertheless, a key difference in the use of the rTMS and electrical stimulation of nerves is their availability.…”

Section: Discussionmentioning

confidence: 99%

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

Leszczyńska

Huber

2023

Biomedicines

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Efforts to find therapeutic methods that support spinal cord functional regeneration continue to be desirable. Natural recovery is limited, so high hopes are being placed on neuromodulation methods which promote neuroplasticity, such as repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation used as treatment options for managing incomplete spinal cord injury (iSCI) apart from kinesiotherapy. However, there is still no agreement on the methodology and algorithms for treatment with these methods. The search for effective therapy is also hampered by the use of different, often subjective in nature, evaluation methods and difficulties in assessing the actual results of the therapy versus the phenomenon of spontaneous spinal cord regeneration. In this study, an analysis was performed on the database of five trials, and the cumulative data are presented. Participants (iSCI patients) were divided into five groups on the basis of the treatment they had received: rTMS and kinesiotherapy (N = 36), peripheral electrotherapy and kinesiotherapy (N = 65), kinesiotherapy alone (N = 55), rTMS only (N = 34), and peripheral electrotherapy mainly (N = 53). We present changes in amplitudes and frequencies of the motor units’ action potentials recorded by surface electromyography (sEMG) from the tibialis anterior—the index muscle for the lower extremity and the percentage of improvement in sEMG results before and after the applied therapies. The increase in values in sEMG parameters represents the better ability of motor units to recruit and, thus, improvement of neural efferent transmission. Our results indicate that peripheral electrotherapy provides a higher percentage of neurophysiological improvement than rTMS; however, the use of any of these additional stimulation methods (rTMS or peripheral electrotherapy) provided better results than the use of kinesiotherapy alone. The best improvement of tibialis anterior motor units’ activity in iSCI patients provided the application of electrotherapy conjoined with kinesiotherapy and rTMS conjoined with kinesiotherapy. We also undertook a review of the current literature to identify and summarise available works which address the use of rTMS or peripheral electrotherapy as neuromodulation treatment options in patients after iSCI. Our goal is to encourage other clinicians to implement both types of stimulation into the neurorehabilitation program for subjects after iSCI and evaluate their effectiveness with neurophysiological tests such as sEMG so further results and algorithms can be compared across studies. Facilitating the motor rehabilitation process by combining two rehabilitation procedures together was confirmed.

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Section: Discussionmentioning

confidence: 99%

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

Leszczyńska

Huber

2023

Biomedicines

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“…Simultaneous recordings using the two techniques have the potential to improve our understanding of how motor unit firing patterns are reflected in the sEMG. The importance of this scoping review is supported by a recent systematic review on the electrophysiological outcome measures in SCI clinical trials, which indicated 27/64 of clinical trials used sEMG analysis and only 1/64 used intramuscular EMG [ 184 ]. It is reasonable to view sEMG as the primary choice of neurophysiological method in SCI clinical trials, given its non-invasiveness and ease-of-use.…”

Section: Discussionmentioning

confidence: 99%

“…and Korupolu et al . have described the use and benefits of electrophysiological outcome measures, including sEMG, in the context of SCI clinical trials [ 7 , 184 ]. Remaining avenues for improvement include greater standardization as well as ease of implementation.…”

Section: Discussionmentioning

confidence: 99%

Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review

Balbinot

Wiest

et al. 2021

J NeuroEngineering Rehabil

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Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail—including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.

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“…The use of electrophysiology in diagnosing SCI can facilitate patient strati cation, evaluation of adverse events, and prediction of therapeutic outcomes (Korupolu et al 2019). However, various issues arise regarding the establishment of protocols, as electrophysiological studies require specialized, costly equipment and well-trained staff to ensure reliable data acquisition with standardized recording con gurations, test conditions, protocols, and data processing/analysis.…”

Section: Application Of Electrophysiological Measures In Spinal Cord ...mentioning

confidence: 99%

Intelligent Integration of Assessment Tools for Specialized Prognosis in Spinal Cord Injuries: A scoping review

Chrysanthakopoulou,

Koutsojannis,

Matzaroglou

et al. 2023

Preprint

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Spinal cord injury is a life-threatening condition resulting from spinal cord trauma, leading to paralysis, loss of sensation, bowel and bladder control. Accurate assessment tools are crucial for diagnosing and treating spinal cord injuries, and various scales have been developed for this purpose. Additionally, electrophysiological measures, including somatosensory evoked potentials, motor evoked potentials, and nerve conduction studies, can aid in patient stratification. Recent developments in spinal cord injury assessment have shown promise, particularly with the use of advanced imaging techniques and artificial intelligence. Neuroimaging and molecular biomarkers combined with electrophysiological measures, promise to predict outcomes and guide treatment decisions. Machine learning and Artificial intelligence have revolutionized the healthcare industry, including the field of spinal cord injuries, as they can facilitate personalized medicine by accurately predicting. Challenges remain in validating machine learning models and ensuring they are safe and effective for clinical use. Quality data and expertise are crucial for accurately interpreting and applying machine learning results in spinal cord injury management. Moreover, due to artificial intelligence entering healthcare to assist in processing data, electrophysiology can eventually meet the high-quality information it can provide, as it is easier to analyze data recordings from somatosensory evoked potentials and other electrophysiologic measures. Summing up, the integration of advanced imaging techniques, biomarkers, and machine learning leading to maximizing the use and importance of electrophysiology as far as the information it can reveal, has the potential to revolutionize the diagnosis, prognosis, and treatment of spinal cord injuries, leading to improved patient outcomes and personalized care.

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Electrophysiological Outcome Measures in Spinal Cord Injury Clinical Trials: A Systematic Review

Cited by 15 publications

References 73 publications

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review

Intelligent Integration of Assessment Tools for Specialized Prognosis in Spinal Cord Injuries: A scoping review

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