Spinal direct current stimulation with locomotor training in chronic spinal cord injury

Saudi Med J, 2020 · DOI: 10.15537/smj.2020.1.24818 · Published: January 1, 2020

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study investigates the use of transcutaneous spinal direct current stimulation (tsDCS), a non-invasive method, to stimulate spinal circuits and potentially improve corticospinal excitability in individuals with incomplete spinal cord injury (SCI). Two male patients with SCI participated in a double-blind, sham-controlled study, receiving either sham stimulation or tsDCS (one with cathodal, one with anodal) alongside robot-assisted gait training. The study measured various outcomes like walking speed, balance, muscle strength, and spasticity before and after each stimulation arm to assess the effects of tsDCS on functional abilities and neurophysiological parameters.

Study Duration

6 weeks with a washout period of 2 weeks between each arm of the study

Participants

2 male patients with incomplete SCI type ASIA-C at spinal levels T10-T11

Evidence Level

Case Report

Key Findings

1
Cathodal tsDCS increased scores in some outcome measures while decreasing others, and anodal stimulation generally increased scores across all measures.
2
Motor evoked potentials (MEPs) increased after cathodal stimulation but deteriorated after anodal stimulation, indicating different effects on corticospinal excitability.
3
The study concludes that tsDCS can modulate gait parameters, spasticity, and corticospinal excitability in incomplete SCI, suggesting its potential as a therapeutic technique.

Research Summary

This case report explores the effects of transcutaneous spinal direct current stimulation (tsDCS) combined with locomotor training on two male patients with chronic incomplete spinal cord injury (SCI). The study used a double-blind, sham-controlled design where patients received either sham, cathodal, or anodal tsDCS alongside robot-assisted gait training, with outcomes measured before and after each stimulation arm. Results indicated that tsDCS can modulate gait parameters, spasticity, and corticospinal excitability, suggesting its potential as a therapeutic technique to enhance functional outcomes in patients with incomplete SCI.

Practical Implications

Therapeutic Technique

tsDCS can be used as a therapeutic technique in combination with other interventions to induce neuroplastic changes and promote functional outcome measures.

Enhanced Motor Function

Combining tsDCS with gait training appears to enhance lower extremity motor function in patients with incomplete SCI.

Personalized Treatment

Anodal tsDCS can improve lower extremity muscle strength and increase muscle tone, while cathodal tsDCS can be used to decrease spasticity, allowing for personalized treatment strategies.

Study Limitations

1
Small sample size (two patients)
2
Lack of formal statistical tests due to single scores for each outcome
3
The effect of the application of tsDCS on different chronicity of SCI should be assessed.

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