Restricted accessResearch articleFirst published online 2016-8-29
Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: A proof of concept sham-randomized clinical study
BACKGROUND: After cervical spinal cord injury, current options for treatment
of upper extremity motor functions have been limited to traditional approaches. However,
there is a substantial need to explore more rigorous alternative treatments to facilitate
motor recovery.
OBJECTIVE: To demonstrate whether anodal-primary motor cortex (M1)
excitability enhancement (with cathodal-supra orbital area) (atDCS) combined with
robot-assisted arm training (R-AAT) will provide greater improvement in contralateral arm
and hand motor functions compared to sham stimulation (stDCS) and R-AAT in patients with
chronic, incomplete cervical spinal cord injury (iCSCI).
METHODS: In this parallel-group, double-blinded, randomized and
sham-controlled trial, nine participants with chronic iCSCI (AIS C and D level) were
randomized to receive 10 sessions of atDCS or stDSC combined with R-AAT. Feasibility and
tolerability was assessed with attrition rate and occurrence of adverse events, Changes in
arm and hand function were assessed with Jebson Taylor Hand Function Test (JTHFT). Amount
of Use Scale of Motor Activity Log (AOU-MAL), American Spinal Injury Association Upper
Extremity Motor Score and Modified Ashworth Scale (MAS) at baseline, after treatment, and
at two-month follow-up.
RESULTS: None of the participants missed a treatment session or dropped-out
due to adverse events related to the treatment protocol. Participants tended to perform
better in JTHFT and AOU-MAL after treatment. Active group at post-treatment and two-month
follow-up demonstrated better arm and hand performance compared to sham group.
CONCLUSION: These preliminary findings support that modulating excitatory
input of the corticospinal tracts on spinal circuits may be a promising strategy in
improving arm and hand functions in persons with incomplete tetraplegia. Further study is
needed to explore the underlying mechanisms of recovery.
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