Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor-Incomplete Spinal Cord-Injured Individuals
The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor‐incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to...
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| Published in | Artificial organs Vol. 39; no. 10; pp. E176 - E186 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Blackwell Publishing Ltd
01.10.2015
Wiley Subscription Services, Inc |
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| Abstract | The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor‐incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor‐incomplete spinal cord‐injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill‐stepping was essentially augmentative and step‐phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step‐related feedback build upon the stimulation‐induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control. |
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| AbstractList | The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor‐incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (t
SCS
) to modulate this central state of excitability during voluntary treadmill stepping in three motor‐incomplete spinal cord‐injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill‐stepping was essentially augmentative and step‐phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that t
SCS
provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step‐related feedback build upon the stimulation‐induced increased state of excitability in the generation of locomotor activity. Thus, t
SCS
essentially works as an electrical neuroprosthesis augmenting remaining motor control. The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor‐incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor‐incomplete spinal cord‐injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill‐stepping was essentially augmentative and step‐phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step‐related feedback build upon the stimulation‐induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control. The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor-incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor-incomplete spinal cord-injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill-stepping was essentially augmentative and step-phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step-related feedback build upon the stimulation-induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control.The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor-incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor-incomplete spinal cord-injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill-stepping was essentially augmentative and step-phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step-related feedback build upon the stimulation-induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control. The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor-incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor-incomplete spinal cord-injured individuals. Stimulation was applied at 30Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill-stepping was essentially augmentative and step-phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3°±5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step-related feedback build upon the stimulation-induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control. |
| Author | McKay, William B. Mayr, Winfried Krenn, Matthias Hofstoetter, Ursula S. Hofer, Christian Kern, Helmut Danner, Simon M. Minassian, Karen |
| Author_xml | – sequence: 1 givenname: Ursula S. surname: Hofstoetter fullname: Hofstoetter, Ursula S. organization: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria – sequence: 2 givenname: Matthias surname: Krenn fullname: Krenn, Matthias organization: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria – sequence: 3 givenname: Simon M. surname: Danner fullname: Danner, Simon M. organization: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria – sequence: 4 givenname: Christian surname: Hofer fullname: Hofer, Christian organization: Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria – sequence: 5 givenname: Helmut surname: Kern fullname: Kern, Helmut organization: Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria – sequence: 6 givenname: William B. surname: McKay fullname: McKay, William B. organization: Hulse Spinal Cord Injury Lab, Crawford Research Institute, Shepherd Center, GA, Atlanta, USA – sequence: 7 givenname: Winfried surname: Mayr fullname: Mayr, Winfried email: winfried.mayr@meduniwien.ac.at organization: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria – sequence: 8 givenname: Karen surname: Minassian fullname: Minassian, Karen organization: Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26450344$$D View this record in MEDLINE/PubMed |
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| Keywords | Human Transcutaneous spinal cord stimulation Spinal cord injury Neuromodulation Locomotor training |
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| SubjectTerms | Adult Biomechanical Phenomena Electromyography Female Gait - physiology Human Humans Locomotor training Lumbosacral Region Male Muscle, Skeletal - physiopathology Neuromodulation Spinal Cord - physiopathology Spinal Cord Injuries - therapy Spinal cord injury Spinal Cord Stimulation Transcutaneous spinal cord stimulation Walking - physiology |
| Title | Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor-Incomplete Spinal Cord-Injured Individuals |
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