Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury

İnanıcı, Fatma; Brighton, Lorie N.; Samejima, Soshi; Hofstetter, Christoph P.; Moritz, Chet T.

doi:10.1109/tnsre.2021.3049133

Cited by 115 publications

(169 citation statements)

References 59 publications

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“…We also used 400-µs pulse width, which was within the range previously utilized in neuromodulation applications. Specifically, 100-µs pulses were delivered as 10-kHz carrier frequency, within 1-ms bursts at 30 Hz [16][17][18][19]. Additionally, 200 µs pulses were delivered as single pulses or as a train of pulses using a 5-kHz carrier frequency in a recent study by Benavides et al [15].…”

Section: Continuous Cervical Tscs Parameters For Inducing Neuromodulatory Effectmentioning

confidence: 99%

“…Similarly, cervical epidural SCS has been used for promoting volitional hand function in individuals with chronic tetraplegia [5]. Consistent with epidural SCS approaches, noninvasive transcutaneous spinal cord stimulation (tSCS) has also been utilized successfully in applications for improving sensory and motor function during lower-limb voluntary movement [6] and walking using lumbar stimulation [7][8][9][10][11][12], trunk stability and standing with lower thoracic and lumbar stimulation [13,14], and gripping and upper-limb function with cervical stimulation [15][16][17][18][19]. Computer simulations and experimental studies using animal models as well as human studies have shown compelling evidence that electric impulses induced by either implanted epidural or surface non-invasive electrodes can primarily activate the afferent fibers in the posterior roots of the spinal cord [20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

“…Although cervical tSCS is also expected to have similar neuromodulatory effects on the upper-limb muscle function, it has been unexplored relative to lumbar tSCS application until recently. Recent reports have shown impressive therapeutic effects of continuous cervical tSCS [16][17][18]26]. However, little is known about the neural mechanisms and how continuous cervical tSCS affects central nervous system (CNS) excitability and the innervated upper-limb muscles.…”

Section: Introductionmentioning

confidence: 99%

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Low-Intensity and Short-Duration Continuous Cervical Transcutaneous Spinal Cord Stimulation Intervention Does Not Prime the Corticospinal and Spinal Reflex Pathways in Able-Bodied Subjects

Sasaki

Freitas

Sayenko

et al. 2021

JCM

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Cervical transcutaneous spinal cord stimulation (tSCS) has been utilized in applications for improving upper-limb sensory and motor function in patients with spinal cord injury. Although therapeutic effects of continuous cervical tSCS interventions have been reported, neurophysiological mechanisms remain largely unexplored. Specifically, it is not clear whether sub-threshold intensity and 10-min duration continuous cervical tSCS intervention can affect the central nervous system excitability. Therefore, the purpose of this study was to investigate effects of sub-motor-threshold 10-min continuous cervical tSCS applied at rest on the corticospinal and spinal reflex circuit in ten able-bodied individuals. Neurophysiological assessments were conducted to investigate (1) corticospinal excitability via transcranial magnetic stimulation applied on the primary motor cortex to evoke motor-evoked potentials (MEPs) and (2) spinal reflex excitability via single-pulse tSCS applied at the cervical level to evoke posterior root muscle (PRM) reflexes. Measurements were recorded from multiple upper-limb muscles before, during, and after the intervention. Our results showed that low-intensity and short-duration continuous cervical tSCS intervention applied at rest did not significantly affect corticospinal and spinal reflex excitability. The stimulation duration and/or intensity, as well as other stimulating parameters selection, may therefore be critical for inducing neuromodulatory effects during cervical tSCS.

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Section: Continuous Cervical Tscs Parameters For Inducing Neuromodulatory Effectmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low-Intensity and Short-Duration Continuous Cervical Transcutaneous Spinal Cord Stimulation Intervention Does Not Prime the Corticospinal and Spinal Reflex Pathways in Able-Bodied Subjects

Sasaki

Freitas

Sayenko

et al. 2021

JCM

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“…Additionally, there are reports that acute and chronic TES of the spinal cord can prove beneficial for cardiovascular function (133,134). TES of the cervical cord already shows promising results for breathing and coughing function (135) as well as improvement in arm function in humans (136)(137)(138)(139). Thus, although not the focus of this review, TES may be a feasible approach to facilitate respiratory neuroplasticity, and it certainly warrants further investigation.…”

Section: Ees To Restore Motor Function After Scimentioning

confidence: 98%

Electrical epidural stimulation of the cervical spinal cord: implications for spinal respiratory neuroplasticity after spinal cord injury

Malone

Nosacka

Nash

et al. 2021

Journal of Neurophysiology

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Traumatic cervical spinal cord injury (cSCI) can lead to damage of bulbospinal pathways to the respiratory motor nuclei and consequent life-threatening respiratory insufficiency due to respiratory muscle paralysis/paresis. Reports of electrical epidural stimulation (EES) of the lumbosacral spinal cord to enable locomotor function after SCI are encouraging, with some evidence of facilitating neural plasticity. Here, we detail the development and success of EES in recovering locomotor function with consideration of stimulation parameters and safety measures to develop effective EES protocols. EES is just beginning to be applied in other motor, sensory, and autonomic systems; however, there has only been moderate success in preclinical studies aimed at improving breathing function after cSCI. Thus, we explore rationale for applying EES to the cervical spinal cord, targeting the phrenic motor nucleus for the restoration of breathing. We also suggest cellular/molecular mechanisms by which EES may induce respiratory plasticity including a brief examination of sex-related differences in these mechanisms. Finally, we suggest more attention be paid to the effects of specific electrical parameters that have been used in the development of EES protocols and how that can impact the safety and efficacy for those receiving this therapy. Ultimately, we aim to inform readers about the potential benefits of EES in the phrenic motor system and encourage future studies in this area.

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“…Interestingly, studies have shown that transcutaneous spinal cord stimulation of the dorsal lumbar region activates the spinal locomotor network (Gorodnichev et al, 2012;Musienko et al, 2013;Gerasimenko et al, 2015). It also reduces some manifestations of spasticity in complete or incomplete SCI subjects, such as the resistance to passive stretch and the occurrence of muscle spasms evoked by cutaneous stimulation (Hofstoetter et al, 2014(Hofstoetter et al, , 2020Estes et al, 2017;Inanici et al, 2021). These reductions might be due to the activation of spinal circuits receiving inputs from the lumbar skin.…”

Section: Functional and Clinical Considerationsmentioning

confidence: 99%

Inhibition and Facilitation of the Spinal Locomotor Central Pattern Generator and Reflex Circuits by Somatosensory Feedback From the Lumbar and Perineal Regions After Spinal Cord Injury

2021

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Somatosensory feedback from peripheral receptors dynamically interacts with networks located in the spinal cord and brain to control mammalian locomotion. Although somatosensory feedback from the limbs plays a major role in regulating locomotor output, those from other regions, such as lumbar and perineal areas also shape locomotor activity. In mammals with a complete spinal cord injury, inputs from the lumbar region powerfully inhibit hindlimb locomotion, while those from the perineal region facilitate it. Our recent work in cats with a complete spinal cord injury shows that they also have opposite effects on cutaneous reflexes from the foot. Lumbar inputs increase the gain of reflexes while those from the perineal region decrease it. The purpose of this review is to discuss how somatosensory feedback from the lumbar and perineal regions modulate the spinal locomotor central pattern generator and reflex circuits after spinal cord injury and the possible mechanisms involved. We also discuss how spinal cord injury can lead to a loss of functional specificity through the abnormal activation of functions by somatosensory feedback, such as the concurrent activation of locomotion and micturition. Lastly, we discuss the potential functions of somatosensory feedback from the lumbar and perineal regions and their potential for promoting motor recovery after spinal cord injury.

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Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury

Cited by 115 publications

References 59 publications

Low-Intensity and Short-Duration Continuous Cervical Transcutaneous Spinal Cord Stimulation Intervention Does Not Prime the Corticospinal and Spinal Reflex Pathways in Able-Bodied Subjects

Low-Intensity and Short-Duration Continuous Cervical Transcutaneous Spinal Cord Stimulation Intervention Does Not Prime the Corticospinal and Spinal Reflex Pathways in Able-Bodied Subjects

Electrical epidural stimulation of the cervical spinal cord: implications for spinal respiratory neuroplasticity after spinal cord injury

Inhibition and Facilitation of the Spinal Locomotor Central Pattern Generator and Reflex Circuits by Somatosensory Feedback From the Lumbar and Perineal Regions After Spinal Cord Injury

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