Effect of spinal cord stimulation on motor performances in hemiplegics

Spinal cord stimulation (SCS) was performed in 11 patients with stabilized spastic hemiparesis due to cerebrovascular ischaemic accident in order to improve their motor performances. The patients were studied before and after 5-7 days of stimulation of the cervical cord according to the following protocol: (1) clinical evaluation based on assessment of the neurological status and on Albert's motor scale and (2) neurophysiological evaluation of reflex voluntary and involuntary motor activity, obtained by means of surface electromyography. Improvement in motor performance following SCS occurred in 7 of the 11 patients. The effect appeared to be particularly evident during specific voluntary movements and gait. Analysis of the electromyography recordings showed that SCS mainly broke down pathological patterns of voluntary movement and reduced agonist-antagonist coactivation and clonus. A relationship between motor outcome and status of the sensory function was noticed as well. We conclude that SCS may play a role in the motor rehabilitation of post-stroke patients with spastic hemiparesis, provided that a careful selection be made before surgery.