Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy.

Stephen Estes,Anastasia Zarkou,Cazmon Suri,Jasmine M Hope,Edelle C Field-Fote

doi:10.3390/jcm10061167

Abstract

Locomotor training (LT) is intended to improve walking function and can also reduce spasticity in motor-incomplete spinal cord injury (MISCI). Transcutaneous spinal stimulation (TSS) also influences these outcomes. We assessed feasibility and preliminary efficacy of combined LT + TSS during inpatient rehabilitation in a randomized, sham-controlled, pragmatic study. Eighteen individuals with subacute MISCI (2–6 months post-SCI) were enrolled and randomly assigned to the LT + TSS or the LT + TSSsham intervention group. Participants completed a 4-week program consisting of a 2-week wash-in period (LT only) then a 2-week intervention period (LT + TSS or LT + TSSsham). Before and after each 2-week period, walking (10 m walk test, 2-min walk test, step length asymmetry) and spasticity (pendulum test, clonus drop test, modified spinal cord injury—spasticity evaluation tool) were assessed. Sixteen participants completed the study. Both groups improved in walking speed and distance. While there were no significant between-groups differences, the LT + TSS group had significant improvements in walking outcomes following the intervention period; conversely, improvements in the LT + TSSsham group were not significant. Neither group had significant changes in spasticity, and the large amount of variability in spasticity may have obscured ability to observe change in these measures. TSS is a feasible adjunct to LT in the subacute stage of SCI and may have potential to augment training-related improvements in walking outcomes.

Highlights

The loss of motor control is a hallmark of spinal cord injury (SCI), impacting the health and quality of life for persons with a SCI
A total of 107 potential participants were screened for eligibility, and 18 were enrolled, resulting in an enrollment rate of 17% (See Flow Diagram, Figure 2)
One participant was withdrawn before training activities began because they decided to focus their time on therapy rather than study-related assessments

Summary

Introduction

The loss of motor control is a hallmark of spinal cord injury (SCI), impacting the health and quality of life for persons with a SCI. To overcome these impairments, rehabilitation therapies aim to improve motor control and maximize functional recovery by optimally activating spared pathways. LT is thought to activate use-dependent neural mechanisms within spared neuronal circuits to improve motor control and walking function [2]. While improvements in walking function have been observed following LT, randomized studies have demonstrated that no single approach appears to be superior to others [3]. Improvements have been modest and it has been suggested that combination approaches may offer the greatest promise. There has been increased interest in combining traditional LT strategies with novel neurotherapeutic approaches to amplify these mechanisms [4,5,6]

Objectives

Methods

Results

Discussion

Conclusion