Abstract
Paired associative nerve stimulation (PANS) was proposed as a potential nerve rehabilitation treatment strategy. However, few relevant documents are available regarding the strategy, and only a few clinical studies have involved healthy people. To determine the feasibility of the neurorehabilitation treatment and to estimate the effect of PANS on nerve plasticity for individuals with incomplete spinal cord injury (iSCI), a design combining repetitive transcranial magnetic stimulation (rTMS) with trans-spinal electrical stimulation was developed for treating individuals with iSCI in this pilot case study. First, a novel PANS system with multiple stimulation modes was designed and verified with resistors and a metal coil as load. Then, the system was applied to three individuals with iSCI, and five types of paired associative stimulation was performed to confirm the feasibility of the system and determine the most effective treatment strategy. The preliminary result showed that 20-Hz rTMS combined with cathodal trans-spinal direct current stimulation (tsDCS) had the greatest effect on corticospinal excitability. Next, stimulations of 20-Hz rTMS (brain) and sham (spine) as well as sham (brain) and cathode tsDCS (spine) were administered to individuals with iSCI, and the results revealed that paired associative stimulation of brain and spine was more effective than only 20-Hz rTMS brain stimulation or cathodal tsDCS stimulation for corticospinal plasticity.
Highlights
P EOPLE with spinal cord injury (SCI) usually lose sensory and motor function of extremities depending on the severity and location of the injury [1]
The amplitudes of motor-evoked potential (MEP) in the left lower leg increased by approximately 83%, 45%, 69%, and 41%, respectively, after different types of Paired associative nerve stimulation (PANS) were applied, whereas no considerable change was observed after sham stimulation in the incomplete SCI (iSCI) participants
As combined 20-Hz repetitive transcranial magnetic stimulation (rTMS) and trans-spinal direct current stimulation (tsDCS) intervention could produce the highest MEP, the present study used this parameter to evaluate the effects of only rTMS or trans-spinal electrical stimulation (tsES) management in the iSCI patients
Summary
P EOPLE with spinal cord injury (SCI) usually lose sensory and motor function of extremities depending on the severity and location of the injury [1]. Following SCI, brain reorganization and motor neuronal connection from the brain to spinal cord play a crucial role in the recovery and rehabilitation of sensory and motor dysfunctions of distal limbs [2], [3]. Individuals with incomplete SCI (iSCI) may regain walking ability to some extent [2], [3]. Strengthening the plasticity of brain and spinal cord for optimizing the functional outcome in people with SCI remains a challenge. Both repetitive transcranial magnetic stimulation (rTMS) and trans-spinal electrical stimulation (tsES) have become popular neuroplasticity methods that improve motor function
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