Kelsey A Potter-Baker1,2, Daniel P Janini1, Yin-Liang Lin1, Vishwanath Sankarasubramanian1, David A Cunningham3, Nicole M Varnerin1, Patrick Chabra1, Kevin L Kilgore4,5,6, Mary Ann Richmond7,8, Frederick S Frost9, Ela B Plow1,9,10. 1. a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic Foundation , Cleveland , Ohio , USA. 2. b Advanced Platform Technology Center , Louis Stokes Cleveland Department of Veteran's Affairs , Cleveland , Ohio , USA. 3. c Kessler Foundation , Human Performance & Engineering Laboratory , West Orange , New Jersey , USA. 4. d Functional Electrical Stimulation Center , Louis Stokes Cleveland Department of Veteran's Affairs , Cleveland , Ohio , USA. 5. e Department of Orthopaedics , Case Western Reserve University School of Medicine , Cleveland , Ohio , USA. 6. f Department of Orthopaedics , MetroHealth Medical Center , Cleveland , Ohio , USA. 7. g Spinal Cord Injury and Disorders Service , Louis Stokes Cleveland Department of Veteran's Affairs , Cleveland , Ohio , USA. 8. h Department of Medicine , Case Western Reserve University School of Medicine , Cleveland , Ohio , USA. 9. i Department of Physical Medicine and Rehabilitation , Neurological Institute, Cleveland Clinic Foundation , Cleveland , Ohio , USA. 10. j Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic Foundation , Cleveland , Ohio , USA.
Abstract
OBJECTIVE: Our goal was to determine if pairing transcranial direct current stimulation (tDCS) with rehabilitation for two weeks could augment adaptive plasticity offered by these residual pathways to elicit longer-lasting improvements in motor function in incomplete spinal cord injury (iSCI). DESIGN: Longitudinal, randomized, controlled, double-blinded cohort study. SETTING: Cleveland Clinic Foundation, Cleveland, Ohio, USA. PARTICIPANTS: Eight male subjects with chronic incomplete motor tetraplegia. INTERVENTIONS: Massed practice (MP) training with or without tDCS for 2 hrs, 5 times a week. OUTCOME MEASURES: We assessed neurophysiologic and functional outcomes before, after and three months following intervention. Neurophysiologic measures were collected with transcranial magnetic stimulation (TMS). TMS measures included excitability, representational volume, area and distribution of a weaker and stronger muscle motor map. Functional assessments included a manual muscle test (MMT), upper extremity motor score (UEMS), action research arm test (ARAT) and nine hole peg test (NHPT). RESULTS: We observed that subjects receiving training paired with tDCS had more increased strength of weak proximal (15% vs 10%), wrist (22% vs 10%) and hand (39% vs. 16%) muscles immediately and three months after intervention compared to the sham group. Our observed changes in muscle strength were related to decreases in strong muscle map volume (r=0.851), reduced weak muscle excitability (r=0.808), a more focused weak muscle motor map (r=0.675) and movement of weak muscle motor map (r=0.935). CONCLUSION: Overall, our results encourage the establishment of larger clinical trials to confirm the potential benefit of pairing tDCS with training to improve the effectiveness of rehabilitation interventions for individuals with SCI. TRIAL REGISTRATION: NCT01539109.
RCT Entities:
OBJECTIVE: Our goal was to determine if pairing transcranial direct current stimulation (tDCS) with rehabilitation for two weeks could augment adaptive plasticity offered by these residual pathways to elicit longer-lasting improvements in motor function in incomplete spinal cord injury (iSCI). DESIGN: Longitudinal, randomized, controlled, double-blinded cohort study. SETTING: Cleveland Clinic Foundation, Cleveland, Ohio, USA. PARTICIPANTS: Eight male subjects with chronic incomplete motor tetraplegia. INTERVENTIONS: Massed practice (MP) training with or without tDCS for 2 hrs, 5 times a week. OUTCOME MEASURES: We assessed neurophysiologic and functional outcomes before, after and three months following intervention. Neurophysiologic measures were collected with transcranial magnetic stimulation (TMS). TMS measures included excitability, representational volume, area and distribution of a weaker and stronger muscle motor map. Functional assessments included a manual muscle test (MMT), upper extremity motor score (UEMS), action research arm test (ARAT) and nine hole peg test (NHPT). RESULTS: We observed that subjects receiving training paired with tDCS had more increased strength of weak proximal (15% vs 10%), wrist (22% vs 10%) and hand (39% vs. 16%) muscles immediately and three months after intervention compared to the sham group. Our observed changes in muscle strength were related to decreases in strong muscle map volume (r=0.851), reduced weak muscle excitability (r=0.808), a more focused weak muscle motor map (r=0.675) and movement of weak muscle motor map (r=0.935). CONCLUSION: Overall, our results encourage the establishment of larger clinical trials to confirm the potential benefit of pairing tDCS with training to improve the effectiveness of rehabilitation interventions for individuals with SCI. TRIAL REGISTRATION: NCT01539109.
Entities:
Keywords:
Motor recovery; Plasticity; Spinal cord injury; Transcranial direct current stimulation; Transcranial magnetic stimulation
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