Abstract
Transcutaneous spinal stimulation (TSS) and whole-body vibration (WBV) each have a robust ability to activate spinal afferents. Both forms of stimulation have been shown to influence spasticity in persons with spinal cord injury (SCI), and may be viable non-pharmacological approaches to spasticity management. In thirty-two individuals with motor-incomplete SCI, we used a randomized crossover design to compare single-session effects of TSS versus WBV on quadriceps spasticity, as measured by the pendulum test. TSS (50 Hz, 400 μs, 15 min) was delivered in supine through a cathode placed over the thoracic spine (T11-T12) and an anode over the abdomen. WBV (50 Hz; eight 45-s bouts) was delivered with the participants standing on a vibration platform. Pendulum test first swing excursion (FSE) was measured at baseline, immediately post-intervention, and 15 and 45 min post-intervention. In the whole-group analysis, there were no between- or within-group differences of TSS and WBV in the change from baseline FSE to any post-intervention timepoints. Significant correlations between baseline FSE and change in FSE were associated with TSS at all timepoints. In the subgroup analysis, participants with more pronounced spasticity showed significant decreases in spasticity immediately post-TSS and 45 min post-TSS. TSS and WBV are feasible physical therapeutic interventions for the reduction of spasticity, with persistent effects.
Highlights
At discharge from inpatient rehabilitation after spinal cord injury (SCI), more than half of all individuals report experiencing spasticity; a large proportion continue to report that spasticity interferes with function 5 years post-injury [1]
Spasticity was defined for the respondents in an inclusive way, to encompass characteristics associated with the experience of spasticity, including involuntary spasms, spasms triggered by stimuli, and stiffness
In a comparative study of physical therapeutic interventions, Transcutaneous spinal stimulation (TSS), stretching, and continuous passive movement all demonstrated immediate and persistent reductions in spasticity in persons with chronic SCI [15], congruent with the results found in this study
Summary
At discharge from inpatient rehabilitation after spinal cord injury (SCI), more than half of all individuals report experiencing spasticity; a large proportion continue to report that spasticity interferes with function 5 years post-injury [1]. Described as “disordered sensori-motor control presenting as intermittent or sustained involuntary activation of muscles,” [2] spasticity impacts the ability to perform functional movements such as transfers, and can lead to contractures and pain [3]. In a survey that acquired responses from 1076 individuals with SCI, only 38% reported that their spasticity was improved by prescribed antispasmodics [5]. Physical therapeutic interventions such as stretching and exercise were reported to improve spasticity in 48% and 45% of respondents, respectively. In this survey study, spasticity was defined for the respondents in an inclusive way, to encompass characteristics associated with the experience of spasticity, including involuntary spasms, spasms triggered by stimuli, and stiffness
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