Exoskeleton Walk Training in Paralyzed Individuals Benefits From Transcutaneous Lumbar Cord Tonic Electrical Stimulation

Shapkova, E. Yu.; Pismennaya, E V; Emelyannikov, Dmitriy V.; Ivanenko, Yuri P.

doi:10.3389/fnins.2020.00416

Cited by 57 publications

(56 citation statements)

References 51 publications

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“…The use of this intra-pulse carrier frequency is poorly justified and appears to be for analgesic purposes, although no evaluation of this could be identified. Other therapeutic experiments selected simplified phase characteristics with either biphasic or monophasic rectangular-waves with a frequency ranging from 1–90 Hz, with 20–30 Hz the most commonly occurring selection [ 6 , 18 , 19 , 38 , 40 , 44 , 69 , 71 ]. The duration of therapeutic stimulation varied from bouts of <5 mins [ 37 , 40 , 67 ] to > 45 mins [ 36 , 38 , 68 ] and was generally paired with concomitant rehabilitative activities.…”

Section: Resultsmentioning

confidence: 99%

“…Other therapeutic experiments selected simplified phase characteristics with either biphasic or monophasic rectangular-waves with a frequency ranging from 1–90 Hz, with 20–30 Hz the most commonly occurring selection [ 6 , 18 , 19 , 38 , 40 , 44 , 69 , 71 ]. The duration of therapeutic stimulation varied from bouts of <5 mins [ 37 , 40 , 67 ] to > 45 mins [ 36 , 38 , 68 ] and was generally paired with concomitant rehabilitative activities. Recorded current ranges in therapeutic experiments reached a maximum of 180mA in the thoracolumbar region [ 67 ] and 210mA in the cervical region [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

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Transcutaneous spinal cord stimulation and motor responses in individuals with spinal cord injury: A methodological review

et al. 2021

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Background Transcutaneous spinal cord stimulation (tSCS) is a non-invasive modality in which electrodes can stimulate spinal circuitries and facilitate a motor response. This review aimed to evaluate the methodology of studies using tSCS to generate motor activity in persons with spinal cord injury (SCI) and to appraise the quality of included trials. Methods A systematic search for studies published until May 2021 was made of the following databases: EMBASE, Medline (Ovid) and Web of Science. Two reviewers independently screened the studies, extracted the data, and evaluated the quality of included trials. The electrical characteristics of stimulation were summarised to allow for comparison across studies. In addition, the surface electromyography (EMG) recording methods were evaluated. Results A total of 3753 articles were initially screened, of which 25 met the criteria for inclusion. Studies were divided into those using tSCS for neurophysiological investigations of reflex responses (n = 9) and therapeutic investigations of motor recovery (n = 16). The overall quality of evidence was deemed to be poor-to-fair (10.5 ± 4.9) based on the Downs and Black Quality Checklist criteria. The electrical characteristics were collated to establish the dosage range across stimulation trials. The methods employed by included studies relating to stimulation parameters and outcome measurement varied extensively, although some trends are beginning to appear in relation to electrode configuration and EMG outcomes. Conclusion This review outlines the parameters currently employed for tSCS of the cervicothoracic and thoracolumbar regions to produce motor responses. However, to establish standardised procedures for neurophysiological assessments and therapeutic investigations of tSCS, further high-quality investigations are required, ideally utilizing consistent electrophysiological recording methods, and reporting common characteristics of the electrical stimulation administered.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Transcutaneous spinal cord stimulation and motor responses in individuals with spinal cord injury: A methodological review

et al. 2021

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“…At present, although the results of spinal electrical stimulation are expected to play an important role in enhancing motor recovery, the potential for long-term and continuous improvement caused by this technique is likely to require further improvement, such as the biocompatibility of implants [89], noninvasive effectiveness [78,79]. In addition, a combination of treatments, such as exoskeletons [90,91], may be required, as well as medication [92], motor training [58,93].…”

Section: Challenges and Prospectsmentioning

confidence: 99%

Complex Electrical Stimulation Systems in Motor Function Rehabilitation after Spinal Cord Injury

et al. 2021

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Spinal cord injury (SCI) is an existing incurable disease that brings great pain and life obstacles to patients. Spinal cord electrical stimulation is an effective means to alleviate spinal cord injury. However, its complicated mechanism of action is still unclear. This article aims to summarize several different spinal cord electrical stimulation methods, analyze the stimulation effect, and briefly describe the current understanding of its origin and mechanism of action. In recent years, several application cases of the electrical stimulation system of stimulation methods have confirmed its positive effects in spinal cord injury diseases and provided new perspectives for the improvement of spinal cord injury. Finally, the possible development direction and corresponding challenges of spinal cord electrical stimulation in the future are proposed.

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“…Overall, improvements have been modest and it has been suggested that combination approaches may offer the greatest promise. In recent years, there has been increased interest in combining traditional LT strategies with novel neurotherapeutic approaches to amplify these mechanisms [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy

Estes

Zarkou

Hope

et al. 2021

JCM

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Locomotor training (LT) is intended to improve walking function and can also reduce spasticity in motor-incomplete spinal cord injury (MISCI). Transcutaneous spinal stimulation (TSS) also influences these outcomes. We assessed feasibility and preliminary efficacy of combined LT + TSS during inpatient rehabilitation in a randomized, sham-controlled, pragmatic study. Eighteen individuals with subacute MISCI (2–6 months post-SCI) were enrolled and randomly assigned to the LT + TSS or the LT + TSSsham intervention group. Participants completed a 4-week program consisting of a 2-week wash-in period (LT only) then a 2-week intervention period (LT + TSS or LT + TSSsham). Before and after each 2-week period, walking (10 m walk test, 2-min walk test, step length asymmetry) and spasticity (pendulum test, clonus drop test, modified spinal cord injury—spasticity evaluation tool) were assessed. Sixteen participants completed the study. Both groups improved in walking speed and distance. While there were no significant between-groups differences, the LT + TSS group had significant improvements in walking outcomes following the intervention period; conversely, improvements in the LT + TSSsham group were not significant. Neither group had significant changes in spasticity, and the large amount of variability in spasticity may have obscured ability to observe change in these measures. TSS is a feasible adjunct to LT in the subacute stage of SCI and may have potential to augment training-related improvements in walking outcomes.

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Exoskeleton Walk Training in Paralyzed Individuals Benefits From Transcutaneous Lumbar Cord Tonic Electrical Stimulation

Cited by 57 publications

References 51 publications

Transcutaneous spinal cord stimulation and motor responses in individuals with spinal cord injury: A methodological review

Transcutaneous spinal cord stimulation and motor responses in individuals with spinal cord injury: A methodological review

Complex Electrical Stimulation Systems in Motor Function Rehabilitation after Spinal Cord Injury

Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy

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