The journal of spinal cord medicine · 2013
Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury.
Клиническое исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Hofstoetter Ursula S, McKay William B, Tansey Keith E, Mayr Winfried, Kern Helmut, Minassian Karen
Аннотация
CONTEXT/OBJECTIVE: To examine the effects of transcutaneous spinal cord stimulation (tSCS) on lower-limb spasticity.
DESIGN: Interventional pilot study to produce preliminary data.
SETTING: Department of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria.
PARTICIPANTS: Three subjects with chronic motor-incomplete spinal cord injury (SCI) who could walk ≥10 m.
INTERVENTIONS: Two interconnected stimulating skin electrodes (Ø 5 cm) were placed paraspinally at the T11/T12 vertebral levels, and two rectangular electrodes (8 × 13 cm) on the abdomen for the reference. Biphasic 2 ms-width pulses were delivered at 50 Hz for 30 minutes at intensities producing paraesthesias but no motor responses in the lower limbs.
OUTCOME MEASURES: The Wartenberg pendulum test and neurological recordings of surface-electromyography (EMG) were used to assess effects on exaggerated reflex excitability. Non-functional co-activation during volitional movement was evaluated. The timed 10-m walk test provided measures of clinical function.
RESULTS: The index of spasticity derived from the pendulum test changed from 0.8 ± 0.4 pre- to 0.9 ± 0.3 post-stimulation, with an improvement in the subject with the lowest pre-stimulation index. Exaggerated reflex responsiveness was decreased after tSCS across all subjects, with the most profound effect on passive lower-limb movement (pre- to post-tSCS EMG ratio: 0.2 ± 0.1), as was non-functional co-activation during voluntary movement. Gait speed values increased in two subjects by 39%.
CONCLUSION: These preliminary results suggest that tSCS, similar to epidurally delivered stimulation, may be used for spasticity control, without negatively impacting residual motor control in incomplete SCI. Further study in a larger population is warranted.
DESIGN: Interventional pilot study to produce preliminary data.
SETTING: Department of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria.
PARTICIPANTS: Three subjects with chronic motor-incomplete spinal cord injury (SCI) who could walk ≥10 m.
INTERVENTIONS: Two interconnected stimulating skin electrodes (Ø 5 cm) were placed paraspinally at the T11/T12 vertebral levels, and two rectangular electrodes (8 × 13 cm) on the abdomen for the reference. Biphasic 2 ms-width pulses were delivered at 50 Hz for 30 minutes at intensities producing paraesthesias but no motor responses in the lower limbs.
OUTCOME MEASURES: The Wartenberg pendulum test and neurological recordings of surface-electromyography (EMG) were used to assess effects on exaggerated reflex excitability. Non-functional co-activation during volitional movement was evaluated. The timed 10-m walk test provided measures of clinical function.
RESULTS: The index of spasticity derived from the pendulum test changed from 0.8 ± 0.4 pre- to 0.9 ± 0.3 post-stimulation, with an improvement in the subject with the lowest pre-stimulation index. Exaggerated reflex responsiveness was decreased after tSCS across all subjects, with the most profound effect on passive lower-limb movement (pre- to post-tSCS EMG ratio: 0.2 ± 0.1), as was non-functional co-activation during voluntary movement. Gait speed values increased in two subjects by 39%.
CONCLUSION: These preliminary results suggest that tSCS, similar to epidurally delivered stimulation, may be used for spasticity control, without negatively impacting residual motor control in incomplete SCI. Further study in a larger population is warranted.