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Brain-Computer Interface Priming for Cervical Transcutaneous Spinal Cord Stimulation Therapy: An Exploratory Case

Ciarán McGeady1, Aleksandra Vučković1, Niraj Singh Tharu2

  • 1Centre for Rehabilitation Engineering, University of Glasgow, Glasgow, United Kingdom.

Frontiers in Rehabilitation Sciences
|October 3, 2022
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Summary

This study explored combining brain-computer interface (BCI) motor priming with transcutaneous spinal cord stimulation (tSCS) for arm and hand function recovery after cervical spinal cord injury (SCI). While both methods improved function, BCI priming showed a moderate benefit for bilateral strength.

Keywords:
brain-computer interfacemotor primingneuromodulationrehabilitationspinal cord injurytranscutaneous spinal cord stimulation

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Biomedical Engineering

Background:

  • Cervical spinal cord injury (SCI) severely impacts arm and hand function, with limited recovery potential despite residual neuronal pathways.
  • Current rehabilitation strategies aim to enhance recovery by combining exercise with techniques like transcutaneous spinal cord stimulation (tSCS) and movement priming.
  • These combined approaches have shown promise in increasing corticospinal excitability and promoting neuroplasticity post-activity-based therapy.

Purpose of the Study:

  • To investigate the synergistic effects of brain-computer interface (BCI) motor priming combined with tSCS-based exercise training.
  • To assess the potential of BCI motor priming to facilitate functional recovery in individuals with chronic, motor-complete cervical SCI.
  • To evaluate improvements in arm and hand strength, sensation, and motor skills following the intervention.

Main Methods:

  • A single participant with chronic AIS A cervical SCI underwent a two-phase, cross-over intervention.
  • Phase 1 involved 15 sessions of intensive tSCS-mediated hand training.
  • Phase 2 involved 15 sessions of tSCS training preceded by bimanual BCI motor priming, separated by a two-week washout period.

Main Results:

  • The participant demonstrated significant improvements in arm and hand function, assessed by the Graded Redefined Assessment for Strength, Sensibility, and Prehension (GRASSP).
  • Scores increased from baseline (96/232) to post-tSCS alone (117/232) and further with BCI priming + tSCS (131/232), indicating enhanced strength, sensation, and motor skills.
  • Neurological level improved from C4 to C5, with maintained gains four weeks post-intervention. Bilateral strength showed moderate improvement specifically with BCI priming prior to tSCS.

Conclusions:

  • Both tSCS training and BCI-primed tSCS training led to considerable improvements in arm and hand function for the participant.
  • While overall functional gains were similar, BCI motor priming may offer a moderate benefit for bilateral strength enhancement in conjunction with tSCS.
  • Further research is warranted to explore the specific benefits of BCI motor priming in SCI rehabilitation protocols.