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Updated: Dec 13, 2025
The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb
Published on: September 23, 2018
Combined botulinum toxin type A and electrical stimulation in individuals with C5-C6 and C6-C7 tetraplegia: a pilot
Francesco Piccione1, Paolo Tonin2, Antonio Cerasa2,3
1IRCCS San Camillo Hospital, Venice, Italy. francesco.piccione@ospedalesancamillo.net.
Study Design:
Single-blind pilot study.
Objectives:
(1) To evaluate combined BoNT-A injection of spastic antagonistic muscles and ES of wrist extensors in order to improve hand function in incomplete cervical SCI patients. (2) To identify prognostic indicators of hand improvements, as a function of motor levels of injury.
Setting:
Ten incomplete asymmetric SCI tetraplegics admitted to San Camillo Hospital (Venezia, Italy), who were not able to perform automatic grasping, were enrolled in the study. A better motor level (BML) C6-C7 and worse motor level (WML) C5-C6 were assigned to take into account asymmetric motor strength.
Methods:
Administration of 100-200 UI BoNT-A per limb into flexor carpi radialis (FCR), extensor digitorum communis (EDC), brachial biceps (BB), and pectoralis major (PM) was performed. This was in conjunction with 6 weeks of 30-min ES sessions repeated three times a day for 6 days a week in wrist extensor muscles, and 6 weeks of 30-min hand rehabilitation for 6 days a week. Assessments included wrist Range of Motion (w-RoM), Modified Ashworth Score (MAS), Functional Independence Measure motor scores (FIM motor), and Nine Hole Peg Test (NHPT).
Results:
Treatments produced a significant reduction in motor spasticity (MAS) and better dexterity (NHPT) in the C6-C7 BML with respect to the WML cases (p level = 0.007; p = 0.01, respectively). FIM motor scores improved more in BML (median: 20; range 20/22) than in WML (median: 10; range 8/17).
Conclusions:
Hand function improvement, determined by combined BONT-A and ES, was better in C6-C7 than in C5-C6 SCI patients.
