Functional electrical stimulation therapy for upper extremity rehabilitation following spinal cord injury: a pilot study

Balbinot, Gustavo; Li, Guijin; Gauthier, Cindy; Musselman, Kristin E.; Kalsi-Ryan, Sukhvinder; Zariffa, José

doi:10.1038/s41394-023-00568-4

Cited by 4 publications

(5 citation statements)

References 62 publications

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“…However, severe paralysis commonly results in a lack of volitional control, making rehabilitation complex and requiring the implementation of neuromodulation strategies. For instance, FES therapy, as demonstrated in studies like ( 8 ), enables the functional activation of upper extremity muscles, even in the most severe paralysis cases, guiding circuit reorganization. Additionally, electrical spinal cord stimulation has proven to have enduring effects, persisting beyond the cessation of stimulation ( 9 , 10 , 27 ).…”

Section: Exploring Regenerative Rehabilitation For Cervical Spinal Co...mentioning

confidence: 99%

“…This efferent volley promotes the contraction of the upper extremity muscles at the appropriate timing for performing the given function. The strong ascending afferent volley conducted by large-diameter sensory fiber signals to the spinal cord ascending systems and reinforce connections related to sensorimotor integration ( 8 ). The activation of these top-down and bottom-up systems by FES therapy in combination with cell and stem cell therapies may help the establishment of the propriospinal circuitry and spinal cord pathways– leading to enhanced recovery of the specific upper extremity function.…”

Section: Case Studies: Regenerative Rehabilitation In Current Clinica...mentioning

confidence: 99%

“…Neuromodulation systems have emerged as a game-changing tool, capable of delivering functional electrical stimulation (FES) to upper extremity muscles with precise timing, evoking reaching and grasping function ( 8 ). Similarly, spinal cord stimulation has proven effective in promoting targeted circuit reorganization in the lumbar spinal cord, culminating in the restoration of standing and walking capabilities, even in the absence of direct stimulation ( 9 , 10 ).…”

Section: Introduction To Regenerative Rehabilitation For Upper Extrem...mentioning

confidence: 99%

“…The segmental recovery after cervical SCIs (C1-T1) displays a proximal-distal gradient, where myotomes innervating proximal upper limb muscles, such as the deltoid and biceps brachii muscles, displays superior recovery compared to distal hand muscles ( 1 , 8 ). Thereby, given its severity and priority for recovery, the optimization of distal hand muscles recovery will likely need targeted and combinatorial approaches.…”

Section: Introduction To Regenerative Rehabilitation For Upper Extrem...mentioning

confidence: 99%

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Neuromodulation to guide circuit reorganization with regenerative therapies in upper extremity rehabilitation following cervical spinal cord injury

Balbinot

2024

Front. Rehabil. Sci.

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Spinal cord injury (SCI) is a profoundly debilitating condition with no effective treatment to date. The complex response of the central nervous system (CNS) to injury and its limited regeneration capacity pose bold challenges for restoring function. Cervical SCIs are the most prevalent and regaining hand function is a top priority for individuals living with cervical SCI. A promising avenue for addressing this challenge arises from the emerging field of regenerative rehabilitation, which combines regenerative biology with physical medicine approaches. The hypothesis for optimizing gains in upper extremity function centers on the integration of targeted neurorehabilitation with novel cell- and stem cell-based therapies. However, the precise roles and synergistic effects of these components remain poorly understood, given the intricate nature of SCI and the diversity of regenerative approaches. This perspective article sheds light on the current state of regenerative rehabilitation for cervical SCI. Notably, preclinical research has yet to fully incorporate rehabilitation protocols that mimic current clinical practices, which often rely on neuromodulation strategies to activate spared circuits below the injury level. Therefore, it becomes imperative to comprehensively investigate the combined effects of neuromodulation and regenerative medicine strategies in animal models before translating these therapies to individuals with SCI. In cases of severe upper extremity paralysis, the advent of neuromodulation strategies, such as corticospinal tract (CST) and spinal cord stimulation, holds promise as the next frontier in enhancing the effectiveness of cell- and stem cell-based therapies. Future preclinical studies should explore this convergence of neuromodulation and regenerative approaches to unlock new possibilities for upper extremity treatment after SCI.

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Section: Exploring Regenerative Rehabilitation For Cervical Spinal Co...mentioning

confidence: 99%

Section: Case Studies: Regenerative Rehabilitation In Current Clinica...mentioning

confidence: 99%

Section: Introduction To Regenerative Rehabilitation For Upper Extrem...mentioning

confidence: 99%

Section: Introduction To Regenerative Rehabilitation For Upper Extrem...mentioning

confidence: 99%

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Neuromodulation to guide circuit reorganization with regenerative therapies in upper extremity rehabilitation following cervical spinal cord injury

Balbinot

2024

Front. Rehabil. Sci.

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“…The data collection was approved by the Research Ethics Board of the University Health Network (REB approval number: 19-5395.6). More details of this data collection can be found in [46]. Briefly, the Bagnoli bipolar electrodes (Delsys, USA) were used to record the sEMG signals during a maximal voluntary contraction.…”

Section: Sci Semg Model Considerationsmentioning

confidence: 99%

A computational model of surface electromyography signal alterations after spinal cord injury

Li,

Balbinot,

Furlan

et al. 2023

J. Neural Eng.

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Spinal cord injury (SCI) can cause significant impairment and disability with an impact on the quality of life for individuals with SCI and their caregivers. Surface electromyography (sEMG) is a sensitive and non-invasive technique to measure muscle activity and has demonstrated great potential in capturing neuromuscular changes resulting from SCI. The mechanisms of the sEMG signal characteristic changes due to SCI are multi-faceted and difficult to study in vivo. In this study, we utilized well-established computational models to characterize changes in sEMG signal after SCI and identify sEMG features that are sensitive and specific to different aspects of the SCI. Starting from existing models for motor neuron pool organization and motor unit action potential generation for healthy neuromuscular systems, we implemented scenarios to model damages to upper motor neurons, lower motor neurons, and the number of muscle fibers within each motor unit. After simulating sEMG signals from each scenario, we extracted time and frequency domain features and investigated the impact of SCI disruptions on sEMG features using the Kendall Rank Correlation analysis. The results indicate that commonly used amplitude-based sEMG features (such as mean absolute values and root mean square) cannot differentiate between injury scenarios, but a broader set of features (including autoregression and cepstrum coefficients) provides greater specificity to the type of damage present. We introduce a novel approach to mechanistically relate sEMG features (often underused in SCI research) to different types of neuromuscular alterations that may occur after SCI. This work contributes to the further understanding and utilization of sEMG in clinical applications, which will ultimately improve patient outcomes after SCI.

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Repertoire of timescales in uni – and transmodal regions mediate working memory capacity

Wolman,

Çatal,

Klar

et al. 2024

NeuroImage

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Functional electrical stimulation therapy for upper extremity rehabilitation following spinal cord injury: a pilot study

Cited by 4 publications

References 62 publications

Neuromodulation to guide circuit reorganization with regenerative therapies in upper extremity rehabilitation following cervical spinal cord injury

Neuromodulation to guide circuit reorganization with regenerative therapies in upper extremity rehabilitation following cervical spinal cord injury

A computational model of surface electromyography signal alterations after spinal cord injury

Repertoire of timescales in uni – and transmodal regions mediate working memory capacity

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