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  4. White matter changes in corticospinal tract associated with improvement in arm and hand functions in incomplete cervical spinal cord injury: pilot case series

White matter changes in corticospinal tract associated with improvement in arm and hand functions in incomplete cervical spinal cord injury: pilot case series

Spinal Cord Series and Cases, 2017 · DOI: 10.1038/scsandc.2017.28 · Published: June 15, 2017

Spinal Cord InjuryNeuroplasticityRehabilitation

Simple Explanation

This study explores whether stimulating the brain with a small electrical current (tDCS) while doing arm exercises can improve arm and hand function in people with incomplete spinal cord injuries. Researchers used brain imaging (DTI) to see if these improvements were related to changes in the white matter of the brain, specifically in the area that controls movement (corticospinal tract). The results suggest that this combined treatment may lead to some improvement in arm and hand function, and that these improvements might be related to changes in the brain's white matter.

Study Duration
2 weeks
Participants
Four right-handed adults with chronic, incomplete cervical SCI
Evidence Level
Pilot case series

Key Findings

  • 1
    Patients who received active tDCS treatment showed greater improvement in hand function and hand usage compared to those who received sham treatment.
  • 2
    There was an overall positive change in FA values across all patients, indicating changes in white matter integrity.
  • 3
    The study demonstrated that in vivo quantification of the CST is feasible in adults with chronic cervical incomplete SCI using 2 mm slices at 3.0 T.

Research Summary

This pilot case series investigated the effects of combined anodal tDCS with robotic-assisted arm training (RAT) on individuals with chronic, incomplete cervical SCI. The study found modest improvement in motor functions in patients treated with anodal tDCS and repetitive training and a positive trend in DTI measures. The results suggest that combination therapy has the potential to facilitate movement recovery, but this must be interpreted with caution because of the very small sample size.

Practical Implications

Potential for Combination Therapy

The study suggests that combining brain stimulation (tDCS) with repetitive arm training may be a promising approach for improving motor function in individuals with incomplete spinal cord injury.

Understanding Neural Mechanisms

The findings provide insights into the neural changes associated with motor recovery after SCI, particularly the role of white matter integrity in the corticospinal tract.

Overcoming Learned Non-Use

The study highlights the importance of addressing learned non-use in rehabilitation strategies to maximize motor function recovery.

Study Limitations

  • 1
    Small sample size (n = 4)
  • 2
    Differences in elapsed time since injury between groups
  • 3
    Interpretation of changes in diffusion in white matter is not straightforward

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