Long-Term Paired Associative Stimulation Enhances Motor Output of the Tetraplegic Hand

JOURNAL OF NEUROTRAUMA, 2017 · DOI: 10.1089/neu.2017.4996 · Published: September 15, 2017

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

This study explores whether long-term Paired Associative Stimulation (PAS) can improve hand motor function in patients with chronic spinal cord injuries. PAS combines transcranial magnetic stimulation (TMS) with peripheral nerve stimulation (PNS) to strengthen neural connections. The study compares PAS to PNS alone, assessing improvements in hand strength and function after treatment and during a follow-up period.

Study Duration

4 weeks

Participants

5 patients with incomplete chronic traumatic tetraplegia

Evidence Level

Level II; Sham-controlled study

Key Findings

1
Long-term PAS resulted in significant improvement in hand motor scores compared to PNS alone in tetraplegic patients.
2
The improvement in the PAS-treated hand continued during the follow-up period, while the PNS-treated hand did not show further improvement.
3
The therapeutic effect of PAS was not due to alleviation of spasticity or changes in peripheral nerves, suggesting LTP-like plasticity at the targeted synapses.

Research Summary

This study investigated the effect of long-term paired associative stimulation (PAS) on hand motor output in patients with chronic tetraplegia, comparing it to peripheral nerve stimulation (PNS). The results showed that PAS significantly improved motor scores in the treated hand compared to PNS alone, with continued improvement during the follow-up period. The study suggests that long-term PAS might be an effective tool for improving motor performance in incomplete chronic SCI patients.

Practical Implications

Rehabilitation strategy

Long-term PAS could be incorporated into rehabilitation programs for SCI patients to improve hand motor function.

Further research

Future studies should explore the effects of PAS in larger patient cohorts, with longer stimulation durations, and at earlier stages after injury.

Underlying mechanisms

Further research is needed to elucidate the extent to which cortical versus spinal mechanisms are involved in the recovery process induced by PAS.

Study Limitations

1
Small sample size (5 patients)
2
The study focused on chronic tetraplegic patients
3
The study duration of 4 weeks may be too short to unveil the full potential of PAS

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