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Updated: Jan 1, 2026
The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb
Published on: September 23, 2018
Paired associative stimulation improves hand function after non-traumatic spinal cord injury: A case series
Aleksandra Tolmacheva1, Sarianna Savolainen1,2, Erika Kirveskari1,3
1HUS Medical Imaging Center, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Finland.
Objectives:
Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with non-traumatic neurological SCI.
Methods:
In this case series, five patients with non-traumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated by manual muscle testing (MMT) before and immediately after the therapy and at the 1- and 6-month follow-ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch test and Box and Block test.
Results:
MMT values of all patients improved at all post-PAS evaluations. The mean ± standard error MMT increase was 1.44 ± 0.37 points (p = 0.043) immediately after PAS, 1.57 ± 0.4 points (p = 0.043) at the 1-month follow-up and 1.71 ± 0.47 points (p = 0.043) at the 6-month follow-up. The pinch test, digital dynamometry and Box and Block test results also improved in all patients.
Conclusions:
Long-term PAS may be a safe and effective treatment for improving hand function in patients with non-traumatic tetraplegia.
Significance:
This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.
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