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Pilot Study Looks at the Benefits of Electrical Stimulation Combined With Intensive Therapy

August 19, 2019

New Craig research evaluating the use of transcutaneous electrical stimulation for individuals with spinal cord injury (SCI) is showing exciting initial results.

The pilot study, which is funded by proceeds from the annual Craig Foundation PUSH Gala fundraiser, seeks to evaluate the overall safety and efficacy of noninvasive transcutaneous spinal cord electrical stimulation using electrodes placed on the surface of the skin directly over the spinal cord.

Transcutaneous Research Study Craig Hospital

Individuals with SCI are typically classified as having an “incomplete” or a “complete” injury.

The spinal cord of a person with an incomplete injury can still convey messages to and from the brain, possibly allowing some sensation or movement below the level of injury. A motor complete injury is indicated by a total lack of motor function below the level of injury.

According to Candy Tefertiller, PT, DPT, Ph.D., NCS, the study’s principal investigator, the distinction is often unclear, and less than 11% of people diagnosed with motor complete injuries have a truly complete injury.

“An individual who has been diagnosed with a motor complete injury might still have intact neural tracts available to carry information through the injury site, though the electrical signal is not strong enough to produce visible movement,” she says.

The study, “Transcutaneous Spinal Cord Stimulation in Combination with Massed Practice Training in Spinal Cord Injury,” is exploring the use of a new device that delivers a much higher frequency of electrical stimulation than currently available commercial devices to increase excitability in the spinal cord. The goal of these stimulators is to essentially “turn up the volume” in the spinal cord so that even weak signals crossing the injury site may become strong enough to facilitate movement below the injury level.

“By putting these electrodes over the spinal cord, the frequency pushes the stimulation into the cord and essentially magnifies any input that was coming from the brain.”

According to Tefertiller, when the stimulator is used over intact circuits, over time they get stronger with continued training and repetition. “They are dormant, so we are waking them up and getting them active again.”

As opposed to traditional functional electronic stimulation, which sends a signal through the skin to make a muscle fire without the patient’s control, this type of stimulation will only enhance the voluntary signal for movement being sent down from the brain, so no muscular contraction will occur unless the individual is intentionally trying to move.

The study is initially enrolling ten patients who have previously plateaued in recovery following completion of the NeuroRecovery program protocol, an intense upper extremity and locomotor therapy program.

Each subject receives 20 three-hour training sessions for both the upper and lower extremities over four weeks, in combination with the transcutaneous stimulation. Subjects are evaluated every 20 sessions and may continue in the study for up to 80 sessions if they are responding well to the stimulation.

The initial results have been promising.

Participant Andrew Ouellette has been able to sit up straight, move his lower extremities on command, and stand supported while the stimulation device is on.

“After several years of not being able to move, it’s incredible to be able to see my legs swinging,” he says. “Especially knowing that it’s my own brain that is making them move.”

Five subjects have been enrolled in the study so far, and Tefertiller hopes to have the study finished in the fall. She plans to write a paper on her findings for submission to a peer-reviewed journal and apply for funding to expand the study to more people.

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Craig is not currently accepting subjects for this initial pilot study. For other open research opportunities, please visit https://craighospital.org/prog....