Individuals with spinal cord injuries (SCI) can experience a loss in function, sensation and strength. Many treatment plans focus on managing symptoms and complications rather than rehabilitation and recovery. Non-invasive neuromodulation techniques offer a way to facilitate recovery through stimulation and have been proven to improve function in people with SCI.
Researchers Monica Perez and Hang Jin Jo investigated the effects of paired corticospinal-motor neuronal stimulation (PCMS) and exercise to enhance recovery in people with spinal cord injuries in their study, “Corticospinal-motor neuronal plasticity promotes exercise-mediated recovery in humans with spinal cord injury.” They studied 38 individuals with spinal cord injuries and randomly divided them into three separate experimental groups. The individuals received either 10 sessions of PCMS and exercise, 10 sessions of sham-PCMS and exercise, or 10 sessions of PCMS alone in the span of 2-3 weeks. During PCMS, transcranial magnetic stimulation (TMS) was delivered at maximum intensity so corticospinal volleys could arrive at corticospinal-motor neuron synapses of specific targeted muscles before the occurrence of antidromic potentials. Immediately following the conduction of PCMS, the participants were instructed to exercise for 45 minutes. These sessions included both upper-limb and lower-limb exercises. Motor evoked potentials (MEPs), maximal voluntary contractions (MVCs) and overall function were measured in all participants before and after their respective treatments. The groups that received PCMS and PCMS with exercise showed significant increases in MEPs and MVCs after 10 sessions of treatment. However, the individuals treated with sham-PCMS and exercise showed virtually no change in their MEPs or MVCs from pre-treatment to post-treatment. All three groups decreased their times to complete functional tests, which correlates to an overall increase in functionality for all participants. The researchers followed up with the participants that received either sham-PCMS and exercise or PCMS and exercise six months after the initial study. They found that those who received PCMS and exercise maintained their increased MEPs, MVCs and functional outcomes while those who received sham-PCMS and exercise did not. This study provides evidence for the positive effects of PCMS on exercise mediated recovery in people with spinal cord injuries.
The study mentioned above focuses on the recovery of people’s ability to ambulate through exercise and PCMS. Individuals with spinal cord injuries also struggle with autonomic functions, like the function of the lower urinary tract (LUT). In the article, “Non-invasive Neuromodulation of Spinal Cord Restores Lower Urinary Tract Function After Paralysis” researchers Parag N. Gad, et. al., studied Transcutaneous Electrical Spinal Stimulation for LUT functional Augmentation (TESSLA), a non-invasive neuromodulatory technique, and its ability to restore the function of the lower urinary tract in individuals with SCI. Seven participants with SCI were recruited and they first received spinal stimulation to map the LUT to spinally evoked responses. Participants also received a baseline urodynamic procedure before receiving urodynamic studies with TESSLA. The researchers found that, “TESSLA delivered at T11 at 1 Hz resulted in improved voiding efficiency (VE), increased flow rate, decreased residual volume and improved coordination between the detrusor and sphincter” (Gad, et. al., 2018). In addition, when the urodynamic studies were delivered without stimulation, participants regressed back to their baseline function. This study shows how the use of TESSLA can facilitate bladder function and recovery by activating neuronal networks that control the lower urinary tract function. Although the study lacks evidence for the long term effects of TESSLA, it offers evidence that this non-invasive technique can be used to help people with SCI gain back control over their autonomic functions.
Both studies used non-invasive neuromodulatory techniques to facilitate recovery in people with SCI. PCMS was proven to promote functional recovery in participants and the functional increases were maintained six months after the treatment. TESSLA proved to be an effective technique to restore bladder function and facilitate voluntary bladder control in individuals with SCI. These findings give hope to individuals with spinal cord injuries. The loss of voluntary control over ambulation and autonomic functions can be very disheartening but these studies, and future studies, offer proven ways to facilitate recovery using non-invasive techniques.
Citations:
Jo, Hang Jin, and Monica A Perez. “Corticospinal-motor neuronal plasticity promotes exercise-mediated recovery in humans with spinal cord injury.” Brain : a journal of neurology vol. 143,5 (2020): 1368-1382. doi:10.1093/brain/awaa052
Gad, Parag N et al. “Non-invasive Neuromodulation of Spinal Cord Restores Lower Urinary Tract Function After Paralysis.” Frontiers in neuroscience vol. 12 432. 29 Jun. 2018, doi:10.3389/fnins.2018.00432
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