Therapeutic potential of transcutaneous electrical spinal stimulation on upper extremity functions in cervical spinal cord injury: a case study
1Inanici F, 1Samejima S, 2Gad P, 2Edgerton R, 1Hofstetter C, 1Moritz C
1University of Washington, Seattle, WA, USA; 2UCLA, Los Angeles, California, USA
Background. Recovery of hand and arm function is the most important priority of individuals with tetraplegia. We aim to determine the therapeutic potential of transcutaneous cervical spinal cord stimulation for restoration of upper extremity functions. We tested the hypothesis that cervical stimulation can facilitate neuroplasticity that results in long–lasting improvement in motor control of the upper extremities.
Methods. A 62-year-old male with incomplete C3 spinal cord injury 2 years prior participated in the study. The intervention comprised three alternating periods: (1) transcutaneous cervical spinal stimulation combined with physical therapy that focused on upper extremity functions (2) identical physical therapy only, and (3) a brief combination of stimulation and physical therapy once again. The Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) test was the primary outcome measure. Pinch strength measurement and International Society for Neurologic Classification of Spinal Cord Injury (ISNCSCI) assessment were performed throughout baseline, intervention and follow-up.
Findings. Following four weeks of combined stimulation and physical therapy, all motor function tests improved remarkably. Total GRASSP score increased 49 points and upper extremity motor score improved 10 points. Pinch force became 2- to 7-fold stronger in left and right hands, respectively. Pinprick and light touch sensations recovered on trunk dermatomes, and overall neurologic level of injury improved from C3 to C4. Most notably, functional gains persisted for over three months.
Interpretation. Motor and sensory recovery after severe chronic cervical spinal cord injury can be enhanced with transcutaneous electrical stimulation when applied simultaneously with sensory motor training. The effect of stimulation was both immediate and long-lasting. The magnitude of the improvements in sensory-motor performance far exceeded previous reports of upper extremity rehabilitation after chronic tetraplegia. These data suggest that non-invasive electrical stimulation of spinal networks can promote substantial plasticity and long-term recovery following spinal cord injury.
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