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Spinal Cord Electrophysiology
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Priming Neural Circuits to Modulate Spinal Reflex Excitability.

Stephen P Estes1, Jennifer A Iddings1, Edelle C Field-Fote2

  • 1Shepherd Center, Crawford Research Institute , Atlanta, GA , USA.

Frontiers in Neurology
|February 21, 2017
PubMed
Summary

Non-pharmacological interventions like stretching, cyclic passive movement (CPM), and transcutaneous spinal cord stimulation (tcSCS) effectively reduce spasticity after spinal cord injury (SCI). CPM and tcSCS demonstrated prolonged spasticity reduction compared to sham treatments.

Keywords:
cyclic passive movementspasticityspinal cord injurystretchingtanscranial direct current stimulationtranscutaneous spinal cord stimulation

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Biomedical Engineering

Background:

  • Spinal cord injury (SCI) frequently leads to spasticity, a condition often managed with medications that carry side effects.
  • Physical and electrotherapeutic interventions offer potential non-pharmacological alternatives for spasticity management.
  • A systematic comparison of these alternative interventions for spasticity reduction is lacking.

Purpose of the Study:

  • To compare the efficacy of four non-pharmacological interventions against a sham-control for reducing spasticity in individuals with chronic SCI.
  • To assess both immediate and delayed effects of these interventions on spasticity.

Main Methods:

  • Ten individuals with chronic SCI (≥1 year) and quadriceps spasticity participated.
  • Four interventions (stretching, cyclic passive movement (CPM), transcutaneous spinal cord stimulation (tcSCS), transcranial direct current stimulation (tDCS)) and a sham-control were administered in a randomized order.
  • Spasticity was measured using the pendulum test immediately and 45 minutes post-intervention.

Main Results:

  • Stretching, CPM, and tcSCS significantly reduced spasticity immediately post-intervention compared to sham.
  • The spasticity reduction persisted for 45 minutes only with CPM and tcSCS.
  • Transcranial direct current stimulation (tDCS) showed no significant effect on spasticity.
  • The sham-control itself led to increased spasticity, suggesting immobility exacerbates the condition.

Conclusions:

  • Stretching, CPM, and tcSCS are effective non-pharmacological options for immediate spasticity reduction in SCI.
  • CPM and tcSCS provide sustained spasticity relief, highlighting their potential for longer-term management.
  • Further research is needed to optimize dosing and timing for these interventions.