Spinal cord injury (SCI) is a central nervous system injury that often leads to motor dysfunction. Non-invasive electrical stimulation of the spinal cord has been recognized as a potential method of reactivating lost spinal neural networks to improve motor recovery and exercise response after SCI. Trans-spinal electrical stimulation (ts-ES) has been found to increase functional gains in people after SCI when applied in combination with other motor training protocols. This project aims to evaluate the effects of non-invasive lumbar spinal cord electrical stimulation on the motor function of trunk and lower limbs in people with SCI after augmenting their locomotor training (treadmill stepping) with step-cycle-based electrical peripheral neural stimulation methods.
This project will evaluate the effects of non-invasive lumbar ts-ES on locomotor function in people with incomplete motor SCI (iSCI) who retain some ability to stand or walk. This study has 3 phases: Baseline assessment - 2 sessions - week 1 -Lab visits #1-2 Locomotor training with varied electrical stimulation- 12 sessions - weeks 2-5 - Lab visits #3-14 (1hr, x3/week) End of training assessment - 2 sessions - week 6- Lab visits #15-16. Specific locomotor deficits of each participant will be evaluated, and their step-cycle-based peripheral muscle or nerve stimulation strategy will be determined accordingly to improve stance or step capacity. After augmenting their locomotor function with muscle or peripheral nerve stimulation-induced activation strategies that address particular and unique motor deficits, they will receive intermittent bouts of stance or locomotor training supplemented with ts-ES. The locomotor training will consist of standing/walking on a treadmill with appropriate bodyweight support and added muscle or peripheral nerve stimulation. Specifically, the project aims to assess the following: 1. Does combined muscle (NMES) or peripheral nerve (PN) stimulation with ts-ES during treadmill stepping facilitate locomotor performance? 2. Does four weeks of combined training as described above (1hrx3/week) facilitate exercise capacity (measured by submaximal VO2) in persons with chronic iSCI?
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Trans-spinal electrical stimulation (ts-ES) at T11-L1 vertebral levels with short pulses at a set frequency (30Hz).
Peripheral nerve (PN) or muscle (NMES) stimulation strategy was developed for each participant to optimize stance/walk capacity based on personal needs/preferences.
Stepping on a treadmill with individually preferred speed.
University of Manitoba
Winnipeg, Manitoba, Canada
RECRUITINGNeurophysiological markers or stepping
Average step length, step height at ankle (cm).
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
Electromyography (EMG) of ankle extensor muscles
Mean RMS amplitude
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
Metabolic function testing
Breath-by-breath analysis of air in/out will be used to measure VO2max (mL/kg/min).
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
6 Min Walk Test
Measure distance (m) covered in 6 min walking, overground with device of choice (if using it at home/in community). Repeat with save device. Verbal encouragement and safety support in place during testing.
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
SCIM-Spinal Cord Independence Measure- Mobility scores
Rick Hansen Institute, Spinal Cord Independence Measure III - Mobility subsection, Questions 12-17. Scale: 0-20. Lower score means less mobility.
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
Autonomic scores
American Spinal Injury Association-Autonomic Standards assessment form-General Autonomic Function \& Lower Urinary tract, bowel, and sexual function components. Scale: 0-48. Lower scores mean less autonomic function.
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
Rate or Perceived Exertion (RPE) of Submaximal VO2 testing
Borg scale from 6-20 (chart used from Heart Online open source). Scale: 6-20. Lower scores mean less exertion (less tiring).
Time frame: Pre-training (on week 1) and within one week from end of training (on week 6)
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