Abstract
ObjectiveIn this study, we evaluated the role of residual supraspinal and afferent signaling and their convergence on the sublesional spinal network in subject diagnosed with complete paralysis (AIS-A).MethodsA combination of electrophysiologic techniques with positional changes and subject-driven reinforcement maneuvers was implemented in this study. Electrical stimulation was applied transcutaneously at the T9-L2 vertebra levels and the spinal cord motor evoked potentials (SEMP) were recorded from leg muscles. To test the influence of positional changes, the subject was placed in (i) supine, (ii) upright with partial body weight bearing and (iii) vertically suspended without body weight bearing positions.ResultsIncrease in amplitude of SEMP was observed during transition from supine to upright position, supporting the role of sensory input in lumbosacral network excitability. Additionally, amplitudes of SEMP were facilitated during reinforcement maneuvers, indicating a supralesional influence on sub-lesional network. After initial assessment, subject underwent rehabilitation therapy with following electrophysiological testing that reviled facilitation of SEMP.ConclusionThese results demonstrate that combination of electrophysiological techniques with positional and reinforcement maneuvers can add to the diagnostics of discomplete SCI. These findings also support an idea that integration of supraspinal and afferent information on sub-lesional circuitry plays a critical role in facilitation of spinal sensorimotor network in discomplete SCI.
Highlights
According to the World Health Organization, global estimate of up to 500,000 people sustain a SCI each year (Kumar et al, 2018)
In a cohort of subjects diagnosed as motor complete (AIS-A or B), attempts to volitionally initiate foot movements resulted in 89% of muscles generating EMG activity, suggesting some level of voluntary control over muscle activity (Moss et al, 2011)
Considering the importance of the functional state of sublesional circuitry in evaluation of spared subfunctional fibers, we hypothesized that the characteristics of spinally evoked motor potentials (SEMP) with transcutaneous stimulation (tSCS) can indicate excitability across several spinal cord segments (Minassian et al, 2007; Dy et al, 2010) and, provide detailed information on motoneuronal pools related to multiple muscles (Courtine et al, 2007)
Summary
A combination of electrophysiologic techniques with positional changes and subject-driven reinforcement maneuvers was implemented in this study. To test the influence of positional changes, the subject was placed in (i) supine, (ii) upright with partial body weight bearing and (iii) vertically suspended without body weight bearing positions
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