Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia

• Published in: IEEE transactions on neural systems and rehabilitation engineering Vol. 26; no. 6; pp. 1272 - 1278
• Main Authors: Inanici, Fatma, Samejima, Soshi, Gad, Parag, Edgerton, V. Reggie, Hofstetter, Christoph P., Moritz, Chet T.
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.06.2018; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Arm - physiopathology; Electric stimulation therapy; Electrical stimulation; Electrical stimuli; engineered plasticity; Evoked Potentials, Motor; Extremities; Functional plasticity; Grasping; Hand - physiopathology; Humans; Injuries; Male; Middle Aged; Motor task performance; Muscles; Neuronal Plasticity; Neuroplasticity; Physical therapy; Physical Therapy Modalities; Quadriplegia - diagnostic imaging; Quadriplegia - rehabilitation; Quality of Life; Recovery; Recovery (Medical); Recovery of Function; Restoration; Spinal cord; Spinal Cord - diagnostic imaging; Spinal cord injuries; Spinal Cord Injuries - diagnostic imaging; Spinal Cord Injuries - rehabilitation; Spinal cord injury; Spinal plasticity; Stimulation; Transcutaneous Electric Nerve Stimulation - adverse effects; Transcutaneous Electric Nerve Stimulation - methods; transcutaneous electrical spinal cord stimulation; Treatment Outcome; Upper Extremity; upper extremity function
• ISSN: 1534-4320; 1558-0210; 1558-0210
• DOI: 10.1109/TNSRE.2018.2834339

Upper extremity function is the highest priority of tetraplegics for improving quality of life. We aim to determine the therapeutic potential of transcutaneous electrical spinal cord stimulation for restoration of upper extremity function. We tested the hypothesis that cervical stimulation can facilitate neuroplasticity that results in long-lasting improvement in motor control. A 62-year-old male with C3, incomplete, chronic spinal cord injury (SCI) participated in the study. The intervention comprised three alternating periods: 1) transcutaneous spinal stimulation combined with physical therapy (PT); 2) identical PT only; and 3) a brief combination of stimulation and PT once again. Following four weeks of combined stimulation and physical therapy training, all of the following outcome measurements improved: the Graded Redefined Assessment of Strength, Sensation, and Prehension test score increased 52 points and upper extremity motor score improved 10 points. Pinch strength increased 2- to 7-fold in left and right hands, respectively. Sensation recovered on trunk dermatomes, and overall neurologic level of injury improved from C3 to C4. Most notably, functional gains persisted for over 3 month follow-up without further treatment. These data suggest that noninvasive electrical stimulation of spinal networks can promote neuroplasticity and long-term recovery following SCI.