Spinal Rhythm Generation by Step-Induced Feedback and Transcutaneous Posterior Root Stimulation in Complete Spinal Cord–Injured Individuals

Minassian, Karen; Hofstoetter, Ursula S.; Danner, Simon M.; Mayr, Winfried; Bruce, Joy; McKay, William; Tansey, Keith E.

doi:10.1177/1545968315591706

Cited by 101 publications

(106 citation statements)

References 55 publications

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“…By the same electrophysiological mechanisms, high frequency-low intensity sensory stimulation induced vasoconstriction and increased blood flow velocity in this study; thus, it is thought that such stimulation could also enhance normal venous return. Moreover, after compression of the veins in the leg using an obstructive blood flow measurement technique, blood flow towards the heart increased by electrical stimulation; this means that it is appropriate to use electrical stimulation to reduce the risk of embolism [31].…”

Section: Discussionmentioning

confidence: 99%

Effect of electrical stimulation on blood flow velocity and vessel size

2017

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AbstractInterferential current electrical stimulation alters blood flow velocity and vessel size. We aimed to investigate the changes in the autonomic nervous system depending on electrical stimulation parameters.Forty-five healthy adult male and female subjects were studied. Bipolar adhesive pad electrodes were used to stimulate the autonomic nervous system at the thoracic vertebrae 1-4 levels for 20 min. Using Doppler ultrasonography, blood flow was measured to determine velocity and vessel size before, immediately after, and 30 min after electrical stimulation.Changes in blood flow velocity were significantly different immediately and 30 min after stimulation. The interaction between intervention periods and groups was significantly different between the exercise and pain stimulation groups immediately after stimulation (p<0.05). The vessel size was significantly different before and 30 min after stimulation (p<0.05).Imbalances in the sympathetic nervous system, which regulates balance throughout the body, may present with various symptoms. Therefore, in the clinical practice, the parameters of electrical stimulation should be selectively applied in accordance with various conditions and changes in form.

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Section: Discussionmentioning

confidence: 99%

Effect of electrical stimulation on blood flow velocity and vessel size

2017

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“…As such, mechanisms of spinal neuromodulation may also include activation of spinal interneural networks and antidromic activation of ascending fibers in the dorsal columns. TSS has been used to increase excitability at multiple levels of the spinal neuraxis to enable motor and autonomic functions in individuals with chronic spinal cord injury (SCI) (Gad et al, 2018; Hofstoetter et al, 2013, 2015; Minassian et al, 2013, 2016; Phillips et al, 2018; Rath et al, 2018; Sayenko et al, 2019). Although TSS has been examined as a possible clinical intervention for individuals with SCI, the promising findings with regard to motor recovery and the noninvasive nature of the technique could make TSS suitable for use with other neurologically‐impaired populations.…”

Section: Introductionmentioning

confidence: 99%

The relationship between maximum tolerance and motor activation during transcutaneous spinal stimulation is unaffected by the carrier frequency or vibration

et al. 2020

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Transcutaneous spinal stimulation (TSS) is a useful tool to modulate spinal sensorimotor circuits and has emerged as a potential treatment for motor disorders in neurologically impaired populations. One major limitation of TSS is the discomfort associated with high levels of stimulation during the experimental procedure. The objective of this study was to examine if the discomfort caused by TSS can be alleviated using different stimulation paradigms in a neurologically intact population. Tolerance to TSS delivered using conventional biphasic balanced rectangular pulses was compared to two alternative stimulation paradigms: a 5 kHz carrier frequency and biphasic balanced rectangular pulses combined with vibrotactile stimulation. In ten healthy participants, tolerance to TSS was examined using both single‐pulse (0.2 Hz) and continuous (30 Hz) stimulation protocols. In both the single‐pulse and continuous stimulation protocols, participants tolerated significantly higher levels of stimulation with the carrier frequency paradigm compared to the other stimulation paradigms. However, when the maximum tolerable stimulation intensity of each stimulation paradigm was normalized to the intensity required to evoke a lower limb muscle response, there were no statistical differences between the stimulation paradigms. Our results suggest that, when considering the intensity of stimulation required to obtain spinally evoked motor potentials, neither alternative stimulation paradigm is more effective at reducing discomfort than the conventional, unmodulated pulse configuration.

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“…The limited clinical evidence suggests that training enhances the excitatory influence of descending pathways recruited by motor cortex TMS and the excitability of inhibitory spinal networks: the inhibition of the common peroneal nerve on TA TMS response is increased after locomotor training in incomplete SCI individuals, as is the inhibitory components of the tibial nerve reflex on the TA. 201 Recent results with epidural or transcutaneous spinal cord stimulation 37,183,202,203 in complete and incomplete SCI individuals demonstrate an enhancement of locomotor activity with stimulation of the dorsal aspect of the lumbar cord. These studies have uncovered a latent volitional control of muscles paralyzed with no evidence of twitch or EMG activity prior to the stimulation being applied.…”

mentioning

confidence: 99%

“…204 The elements activated by the stimulation would involve low threshold dorsal root afferents (proprioceptive and cutaneous) that could in turn activate spinal interneurons to reduce the activation threshold of the locomotor circuitry, allow the few remaining descending fibers to control the activation of the circuitry, and improve the appropriate phase-dependent modulation of the locomotor circuitry by afferent feedback. 202,203,205…”

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confidence: 99%

Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure

Côté

Murray

Lemay

2017

Journal of Neurotrauma

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Body-weight supported locomotor training (BWST) promotes recovery of load-bearing stepping in lower mammals, but its efficacy in individuals with a spinal cord injury (SCI) is limited and highly dependent on injury severity. While animal models with complete spinal transections recover stepping with step-training, motor complete SCI individuals do not, despite similarly intensive training. In this review, we examine the significant differences between humans and animal models that may explain this discrepancy in the results obtained with BWST. We also summarize the known effects of SCI and locomotor training on the muscular, motoneuronal, interneuronal, and supraspinal systems in human and non-human models of SCI and address the potential causes for failure to translate to the clinic. The evidence points to a deficiency in neuronal activation as the mechanism of failure, rather than muscular insufficiency. While motoneuronal and interneuronal systems cannot be directly probed in humans, the changes brought upon by step-training in SCI animal models suggest a beneficial re-organization of the systems' responsiveness to descending and afferent feedback that support locomotor recovery. The literature on partial lesions in humans and animal models clearly demonstrate a greater dependency on supraspinal input to the lumbar cord in humans than in non-human mammals for locomotion. Recent results with epidural stimulation that activates the lumbar interneuronal networks and/or increases the overall excitability of the locomotor centers suggest that these centers are much more dependent on the supraspinal tonic drive in humans. Sensory feedback shapes the locomotor output in animal models but does not appear to be sufficient to drive it in humans.

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Spinal Rhythm Generation by Step-Induced Feedback and Transcutaneous Posterior Root Stimulation in Complete Spinal Cord–Injured Individuals

Cited by 101 publications

References 55 publications

Effect of electrical stimulation on blood flow velocity and vessel size

Effect of electrical stimulation on blood flow velocity and vessel size

The relationship between maximum tolerance and motor activation during transcutaneous spinal stimulation is unaffected by the carrier frequency or vibration

Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure

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