Kosair Charities School of Physical Therapy, Spalding University, Louisville, KY, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
University of California San Francisco, San Francisco, CA, USA.
Neuromodulation. 2024 Jun;27(4):661-671. doi: 10.1016/j.neurom.2023.04.475. Epub 2023 Jun 1.
In adults with cervical spinal cord injury (SCI), transcutaneous spinal stimulation (scTS) has improved upper extremity strength and control. This novel noninvasive neurotherapeutic approach combined with training may modulate the inherent developmental plasticity of children with SCI, providing even greater improvements than training or stimulation alone. Because children with SCI represent a vulnerable population, we first must establish the safety and feasibility of any potential novel therapeutic approach. The objectives of this pilot study were to determine the safety, feasibility, and proof of principle of cervical and thoracic scTS for short-term effect on upper extremity strength in children with SCI.
In this nonrandomized, within-subject repeated measure design, seven participants with chronic cervical SCI performed upper extremity motor tasks without and with cervical (C3-C4 and C6-C7) and thoracic (T10-T11) site scTS. Safety and feasibility of using cervical and thoracic sites scTS were determined by the frequency count of anticipated and unanticipated risks (eg, pain, numbness). Proof-of-principle concept was tested via change in force production during hand motor tasks.
All seven participants tolerated cervical and thoracic scTS across the three days, with a wide range of stimulation intensities (cervical sites = 20-70 mA and thoracic site = 25-190 mA). Skin redness at the stimulation sites was observed in four of 21 assessments (19%) and dissipated in a few hours. No episode of autonomic dysreflexia was observed or reported. Hemodynamic parameters (systolic blood pressure and heart rate) remained within stable limits (p > 0.05) throughout the assessment time points at baseline, with scTS, and after the experiment. Hand-grip and wrist-extension strength increased (p < 0.05) with scTS.
We indicated that short-term application of scTS via two cervical and one thoracic site is safe and feasible in children with SCI and resulted in immediate improvements in hand-grip and wrist-extension strength in the presence of scTS.
The Clinicaltrials.gov registration number for the study is NCT04032990.
在患有颈段脊髓损伤（SCI）的成年人中，经皮脊髓刺激（scTS）已改善上肢力量和控制。这种新颖的非侵入性神经治疗方法与训练相结合，可能会调节 SCI 儿童固有的发育可塑性，提供比单独训练或刺激更大的改善。由于 SCI 儿童是一个弱势群体，我们首先必须确定任何潜在新型治疗方法的安全性和可行性。本研究的目的是确定颈段和胸段 scTS 短期作用于 SCI 儿童上肢力量的安全性、可行性和原理证明。
在这项非随机、自身对照的重复测量设计中，7 名患有慢性颈段 SCI 的参与者在不进行和进行颈段（C3-C4 和 C6-C7）和胸段（T10-T11）部位 scTS 的情况下进行上肢运动任务。使用颈段和胸段部位 scTS 的安全性和可行性通过预期和意外风险（如疼痛、麻木）的频率计数来确定。通过在手运动任务期间的力量产生变化来测试原理证明概念。
所有 7 名参与者在三天内均耐受颈段和胸段 scTS，刺激强度范围很广（颈段部位=20-70 mA，胸段部位=25-190 mA）。在 21 次评估中的 4 次（19%）观察到刺激部位皮肤发红，几小时后消散。未观察到或报告自主神经反射不良事件。整个评估时间点的血流动力学参数（收缩压和心率）均保持在稳定范围内（p>0.05），包括基线、scTS 和实验后。scTS 时，手握力和腕伸肌力量增加（p<0.05）。
我们表明，在 SCI 儿童中，通过两个颈段和一个胸段进行短期 scTS 应用是安全可行的，并且在 scTS 存在的情况下立即改善手握力和腕伸肌力量。
该研究的 Clinicaltrials.gov 注册号为 NCT04032990。
