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

Abstract

Trunk stability is crucial for people with trunk paralysis resulting from spinal cord injuries (SCI), as it plays a significant role in performing daily life activities and preventing from fall-related accidents. Traditional therapy used assistive methods or seating modifications to provide passive assistance while restricting their daily functionality. The recent emergence of neuromodulation techniques has been reported as an alternative therapy that could improve trunk and sitting functions following SCI. The aim of this review was to provide a broad perspective on the existing studies using neuromodulation techniques and identify their potentials in terms of trunk recovery for people with SCI. Five databases were searched (PubMed, Embase, Science Direct, Medline-Ovid, and Web of Science) from inception to December 31, 2022 to identify relevant studies. A total of 21 studies, involving 117 participants with SCI, were included in this review. According to these studies, neuromodulation significantly improved the reaching ability, restored trunk stability and seated posture, increased sitting balance, as well as elevated activity of trunk and back muscles, which were considered early predictors of trunk recovery after SCI. However, there is limited evidence regarding neuromodulation techniques on the improvement of trunk and sitting functions. Therefore, future large-scale randomized controlled trials are warranted to validate these preliminary findings.

Transcutaneous Electrical Spinal Cord Stimulation Increased Target-Specific Muscle Strength and Locomotion in Chronic Spinal Cord Injury

“…TSCS has been used in conjunction with locomotor training, robotic-assisted training and treadmill training to improve gait and locomotion in people with iSCI [12,13,23]. It has been reported that the combined intervention of stimulation and task-based activity could produce better results [21]. The current study aimed to investigate the effects of augmenting ABT to TSCS treatment on enhancing specific lower limb muscle strength and improving locomotor ability in an individual with chronic iSCI.…”

“…Transcutaneous spinal cord electrical stimulation (TSCS) is an emerging treatment with promising outcomes to improve motor function beyond conventional therapy in people with chronic SCI [3]. It is a non-invasive method that uses superficial skin electrodes placed over the spinous processes [1,21]. TSCS could modulate post-SCI motor function [22].…”

Anatomical Registration of Implanted Sensors Improves Accuracy of Trunk Tilt Estimates with a Networked Neuroprosthesis

“…This type of control is convenient when motions are repetitive and not subject to changing external or internal factors but is inappropriate when disturbances that can affect the desired motion are applied to the system. For this reason, feedback control of FNS to compensate for such perturbations has become a prominent topic of interest in research regarding seated trunk stability [ 12 ].…”