Novel Non-invasive Strategy for Spinal Neuromodulation to Control Human Locomotion

Мошонкина, Т. Р.; Гришин, А. М.; Bogacheva, I. N.; Городничев, Р. М.; Ovechkin, Alexander V.; Siu, Ricardo; Edgerton, V. Reggie; Gerasimenko, Yury

doi:10.3389/fnhum.2020.622533

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…Specifically, lumbar spinal electrical stimulation normalized BP regulation in persons with impaired cardiovascular function due to high thoracic or cervical SCI, facilitated temperature regulation in persons with previously dormant sweating function and altered whole body metabolic substrate use, which was associated with reduced perceived exertion during lower limb movement and upper limb exercise. The ability of electrical stimulation of the lumbosacral SC to improve or elicit stepping, stance and even voluntary movement of the lower limbs in persons with motor complete SCI is now well established and has been reviewed elsewhere ( 9 , 10 , 38 , 40 – 44 ). The potential for SCS to also improve cough, sensation, and other autonomic functions such as bladder, bowel, and immune function has been reported or recently reviewed ( 12 – 14 , 33 , 45 – 47 ).…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation at specific phases of the step cycle and at different spinal levels indicates that precisely timed phasic input to spinal neural structures can enable more refined and precise lower limb motor output than tonic stimulation alone ( 44 ). These findings are similar to studies in cat and rat, in which afferent input to different limb joints can have a greater or lesser effect on limb muscle output, depending upon the position of the limb and/or phase of the step cycle in which it is received ( 103 – 106 ).…”

Section: Discussionmentioning

confidence: 99%

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Spinal electrical stimulation to improve sympathetic autonomic functions needed for movement and exercise after spinal cord injury: a scoping clinical review

Flett

Garcia

Cowley

2022

Journal of Neurophysiology

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Spinal cord injury (SCI) results in sensory, motor and autonomic dysfunction. Obesity, cardiovascular and metabolic diseases are highly prevalent after SCI. Although inadequate voluntary activation of skeletal muscle contributes, it is absent or inadequate activation of thoracic spinal sympathetic neural circuitry and sub-optimal activation of homeostatic (cardiovascular, temperature) and metabolic support systems that truly limits exercise capacity, particularly for those with cervical SCI. Thus, when electrical spinal cord stimulation (SCS) studies aimed at improving motor functions began mentioning effects on exercise-related autonomic functions, a potential new area of clinical application appeared. To survey this new area of potential benefit, we performed a systematic scoping review of clinical SCS studies involving these spinally mediated autonomic functions. Nineteen studies were included, 8 used transcutaneous and 11 used epidural SCS. Improvements in BP at rest or in response to orthostatic challenge were investigated most systematically, whereas reports of improved temperature regulation, whole body metabolism and peak exercise performance were mainly anecdotal. Effective stimulation locations and parameters varied between studies, suggesting multiple stimulation parameters and rostrocaudal spinal locations may influence the same sympathetic function. Brainstem and spinal neural mechanisms providing excitatory drive to sympathetic neurons that activate homeostatic and metabolic tissues that provide support for movement and exercise and their integration with locomotor neural circuitry are discussed. A unifying conceptual framework for the integrated neural control of locomotor and sympathetic function is presented which may inform future research needed to take full advantage of SCS for improving these spinally mediated autonomic functions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spinal electrical stimulation to improve sympathetic autonomic functions needed for movement and exercise after spinal cord injury: a scoping clinical review

Flett

Garcia

Cowley

2022

Journal of Neurophysiology

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“…Similarly, when the position of electrodes was changed to the innervation region of the biceps brachii (C5–C6) muscle, it led to the activation of joint movement, thereby improving the elbow’s range of motion [ 125 ]. The stimulus to the lateral side of T11 produced flexion, while at L1 it led to extension during walking [ 126 ], and the stimulation of upper limbs exhibited prolonged changes in neural linkages with continued recovery of hand and arm function in SCI [ 85 ]. Spinal stimulation at multiple sites was found to be effective during functional activities such as locomotion and standing, while region-specific stimulation modulated the upright standing posture [ 127 ].…”

Section: Trans-spinal Pulsed Current Stimulation (Tspcs)mentioning

confidence: 99%

Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review

Rahman

Tharu

Gustin

et al. 2022

JCM

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Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.

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“…The use of tES of the SC in studies on the physiological mechanisms of postural maintenance has a significant advantage—this method allows for non-invasive activation of SC networks, including those in normal subjects, i.e., to study SC neural networks in humans. It has been demonstrated that non-invasive spinal stimulation can precisely modulate the activity not only of the spinal locomotor center but also of the motor pools of the muscles of the lower extremities [ 6 ]. For this reason, tES is particularly useful in the study of posture.…”

Section: Introductionmentioning

confidence: 99%

“…Within the lumbar SC, the flexor and extensor nuclei are anatomically separated [ 4 , 8 ], allowing tES to be used for the targeted control of both flexors and extensors. Recent research has shown that tES at the L1–L2 vertebral level activates lower limb extensors during stepping [ 6 ]. In order to specifically target these muscle groups, active electrodes are placed to the side of the midline of the spinal cord above the dorsal roots.…”

Section: Introductionmentioning

confidence: 99%

Posture of Healthy Subjects Modulated by Transcutaneous Spinal Cord Stimulation

Shamantseva,

Timofeeva,

Gvozdeva

et al. 2023

Life

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Transcutaneous electrical stimulation of the spinal cord is used to restore locomotion and body weight support in patients with severe motor disorders. We studied the effects of this non-invasive stimulation on postural control in healthy subjects. Stimulation at the L1–L2 vertebrae was performed to activate the extensor muscles of the lower limbs. Because postural regulation depends on the cognitive style, the effects of the stimulation were analyzed separately in field-dependent (FD) and field-independent (FI) participants. During the study, FD and FI participants (N = 16, 25 ± 5 years, all right dominant leg) stood on a force platform in a soundproof chamber with their eyes closed. Stimulation was applied in the midline between the L1 and L2 vertebrae or over the left or right dorsal roots of the spinal cord; under the control condition, there was no stimulation. Stimulation destabilized posture in healthy subjects, whereas patients with movement disorders usually showed an improvement in postural control. In the FD participants, left dorsal root and midline stimulation increased several postural parameters by up to 30%. Dorsal root stimulation on the side of the supporting leg reduced postural control, while stimulation on the side of the dominant leg did not. No significant changes were observed in the FI participants.

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Novel Non-invasive Strategy for Spinal Neuromodulation to Control Human Locomotion

Cited by 17 publications

References 19 publications

Spinal electrical stimulation to improve sympathetic autonomic functions needed for movement and exercise after spinal cord injury: a scoping clinical review

Spinal electrical stimulation to improve sympathetic autonomic functions needed for movement and exercise after spinal cord injury: a scoping clinical review

Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review

Posture of Healthy Subjects Modulated by Transcutaneous Spinal Cord Stimulation

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