Via epidural or transcutaneous spinal electrical stimulation is a promising adjunctive modality/therapy for individuals with spinal cord injury (SCI). Stimulation raises the central state of excitability of the neuronal networks, i.e. the physiological state. This heightened state enables greater capacity of spinal networks to integrate task-specific, sensorimotor input and produce sufficient motor output.
- Gerasimenko, Angeli, Harkema, Edgerton, and others have demonstrated application of epidural spinal stimulation (eES) to the spinal cord below the lesion. This was shown to augment the neuromuscular capacity for voluntary movement, standing, stepping, and postural control in individuals with chronic motor complete SCI, sensory incomplete, and some with motor incomplete SCI (1).
- In a recent study, two patients with cervical and mid thoracic SCI achieved over-ground walking after 278 sessions of EES in combination with activity-based locomotor training (AB-LT) (2).
- Transcutaneous spinal cord stimulation (scTS) provides a non-invasive neuromodulatory tool that, similar to eEs, increases the central state of excitability below the lesion (3, 4).
- Rath et al., have demonstrated the efficacy of scTS to acutely improve sitting posture and trunk muscle activation in adults with SCI (5).
- In another study, Sayenko et al., determined that scTS can enable unassisted (n=7) or minimally assisted standing (n=8) in 15 adults with chronic SCI (6).
- Children with SCI may not only benefit from novel neurotherapeutic interventions, but also may demonstrate even greater improvements due to inherent plasticity present during development (7).
- To date, currently only one study in a pediatric population, specifically children with cerebral palsy, demonstrated the efficacy of scTS in combination with AB-LT to significantly improve locomotion as compared to AB-LT alone (8).
- Below is the list of ongoing clinical trials investigating the safety, feasibility and proof-of- principle of scTS to potentiate neuromuscular capacity in children with SCI.
- Transcutaneous Spinal Stimulation: Safety and Feasibility for Trunk Control in Children with Spinal Cord Injury” (ClinicalTrials.gov Identifier: NCT03975634)
- Transcutaneous Spinal Stimulation: Safety and Feasibility for Upper Limb Function in Children with Spinal Cord Injury” (ClinicalTrials.gov Identifier: NCT04032990)
- Neuromodulation of Spinal Locomotor Circuitry to Elicit Stepping after Pediatric Spinal Cord Injury (ClinicalTrials.gov Identifier: NCT04077346)
Articles selected by:
- Anastasia Keller, PhD, Post-doctoral Associate, Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY
- Goutam Singh, PhD, Post-doctoral Associate, Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY
- Yury Gerasimenko, PhD, Professor, Dept. of Physiology, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY