PILOT STUDY OF COMBINED TRANSVERTEBRAL MAGNETIC AND TRANSCUTANEOUS STIMULATION FOR THE REHABILITATION OF COMBAT ACUTE SPINAL CORD INJURIES.

AIM OF THE STUDY

To improve the effectiveness of neurorehabilitation in patients with severe combat spinal cord injury by combining spinal cord repetitive transvertebral magnetic stimulation (rTvMS) and non-invasive transcutaneous electrical stimulation (TcES) of peripheral nerves.

CLINICAL RATIONALE FOR STUDY

For the best recovery from severe combat spinal cord injury, neurorehabilitation must start in the acute phase. Only technologies targeting sensorimotor conduction and functional improvement can confirm the potential of the time factor. Non-invasive neuromodulation has been shown to work for combat spinal cord injury of varying severity.

MATERIAL AND METHODS

We have analysed 154 cases of severe combat spinal cord injury, followed continuously for at least 12 months from the start of neurorehabilitation. A unified «end-to-end» protocol combined rTvMS of the spinal cord with simultaneous TcES of peripheral nerves in different modes was developed for non-invasive spinal cord neuromodulation.

RESULTS

The combination of these parameters produced the most positive results in post-traumatic sensory-motor disorders: (). rTvMS, level ThX-LI: 2000 pulses per set, 100 pulse packages, 5-10 Hz, intensity "+ 30--40%" of the threshold of the evoked motor potential; TcES n. tibialis or n. peroneus: 5-10 Hz, pulse intensity corresponded to the threshold of the motor response, functional electrical stimulation (FES) mode. (). rTvMS, level C-Th: 2000 pulses per set, 50 pulse packages, 5-7 Hz, intensity + 20-30% of the threshold of the evoked motor potential; TcES n. medianus or n. ulnaris; n. tibialis or n. peroneus: 5-10 Hz, pulse intensity corresponded to the threshold of the motor response, FES mode. Approximately 28% of patients in group A (FRANKEL/ASIA) moved to a higher level of function after 3 courses of neurorehabilitation intervention (90 working days).

CONCLUSIONS AND CLINICAL IMPLICATIONS

Electro-magnetic stimulation of the spinal cord excitatory cell conduction system according to the principle of "end-to-end: as in Hebb's theory," combined with physical movement, led to an increase in spinal cord conduction in the acute phase of combat spinal cord injury. This was manifested by neurological and functional improvement.