Noninvasive spinal cord electrical stimulation in the complex rehabilitation of patients with spinal cord injury

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Background. Spinal cord injury causes significant impairments of both motor and pelvic organ functions. Latest studies have shown impressive potentials for using transcutaneous spinal cord electrical stimulation (TcSCES) in the late period of injury to restore motor functions. All results were obtained in a limited number of patients in the specific conditions of a physiological experiment. It remains unclear how effective a TcSCES cycle is in restoring motor activity in patients after spinal cord injury in real clinical conditions. Objective. The main objective of this investigation was to study the effectiveness of TcSCES in combination with the standard rehabilitation of patients after a spinal cord injury. An additional objective was to evaluate the effect of TcSCES to excretory functions in patients with spinal cord injury. Subjects and methods. The studies were conducted at Saint Petersburg City Hospital Forty, which included 15 patients with thoracic spinal injury at 2.4±2.06 years after injury; the severity of the latter was American Spinal Injury Association (ASIA) Grades B and C. All the patients underwent a 2-week standard cycle of rehabilitation treatment; of them 7 patients (a study group) received additionally TcSCES. Standard scales were used to assess neurological status and muscle strength and sensitivity. The patients filled out a urinary diary; residual urine volume was monitored using bladder catheterization or ultrasound. Results. An increase in muscle strength was recorded in 6 patients of the study group and in 1 patient of the control one. The end of the treatment cycle was marked by a 1-score spasticity increase in 1 patient of the study group and in 2 patients in the control one. In the study group, the level of anesthesia decreased per segment in 1 patient; an improvement in deep and proprioceptive sensitivity was recorded in 2 patients; no change in sensitivity was observed in the control group. In the study group, 2 patients showed a reduction in the severity of injury from ASIA Grade B to ASIA Grade C. In three patients of the study group, the residual urine volume decreased and control and a sensation of urgency to urinate appeared; in the control group, these parameters remained unchanged after the treatment cycle. Discussion. The main result of the study is evidence for the efficiency of using TcSCES in the complex therapy of motor neurorehabilitation. The performed cycle of TcSCES in patients was noted to result in better motor and excretory functions. Conclusion. The use of a short-term TcSCES cycle in the motor rehabilitation program for patients with spinal cord injury contributes to recovery of severe motor disorders and is accompanied by an improvement in urinary functions.

Keywords:

spinal injury

spinal stimulation

rehabilitation

urinal control

Authors:

Savenkova A.A.

City Hospital Forty, Saint Petersburg, Russia

Sarana A.M.

City Hospital Forty, Saint Petersburg, Russia;
Saint Petersburg State University, Saint Petersburg, Russia

Shcherbak S.G.

City Hospital Forty, Saint Petersburg, Russia;
Saint Petersburg State University, Saint Petersburg, Russia

Gerasimenko Yu.P.

Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Peterburg, Russia;
«Kosyma» Ltd., Moscow, Russia

Moshonkina T.R.

Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Peterburg, Russia;
«Kosyma» Ltd., Moscow, Russia

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