Ep 20: Spinal Cord Stimulation for Locomotor Recovery after CVA

In Episode 20, Kelly McKenzie, PT, DPT, NCS, Senior Physical Therapist at the Shirley Ryan Ability Lab walks us through the use of spinal cord stimulation to facilitate gait rehabilitation.

In addition to reviewing research on SCS in spinal cord injured patients, Kelly also introduces research into the use of SCS in individuals post-stroke. Kelly highlights research from her lab indicating downregulation at the spinal cord level for individuals post-stroke, and describes ongoing research from her lab to utilize transcutaneous spinal cord stimulation to promote improved gait symmetry after CVA.

To learn more about this series or to request additional information from ReWalk Robotics, please reach out to us via our contact form here: https://rewalk.com/contact/

In case you missed last month’s episode, be sure to check out Topics in NeuroRehabilitation Episode 19: https://www.youtube.com/watch?v=wwGNT…

To learn more about Kelly’s work at the Shirley Ryan Ability Lab and the research referenced in her talk, please visit the links below: Max Nader Center for Rehabilitation Technologies and Outcomes Research: https://www.sralab.org/research/labs/…

References:

Moon, Yaejin, et al. “Improvement in Gait Function After Receiving Noninvasive Spinal Stimulation Combined With Gait Training in Chronic Stroke Survivors.” Archives of Physical Medicine and Rehabilitation 101.11 (2020): e46. https://www.archives-pmr.org/article/…

Rejc E, Angeli C, Harkema S. Effects of Lumbosacral Spinal Cord Epidural Stimulation for Standing after Chronic Complete Paralysis in Humans. PLoS One. 2015;10(7):e0133998. Published 2015 Jul 24. doi:10.1371/journal.pone.0133998

Rejc E, Angeli CA, Bryant N, Harkema SJ. Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics. J Neurotrauma. 2017;34(9):1787–1802. doi:10.1089/neu.2016.4516

Gill ML, Grahn PJ, Calvert JS et al. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat Med. 2018;24, 1677–1682. doi:10.1038/s41591-018-0175-7

Harkema SJ, Gerasimenko Y, Hodes J, et al. Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. The Lancet. 2011;377(9781):1938-1947.

Angeli CA, Edgerton VR, Gerasimenko YP, Harkema SJ. Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans [published correction appears in Brain. 2015 Feb;138(Pt 2):e330]. Brain. 2014;137(Pt 5):1394–1409. doi:10.1093/brain/awu038

Angeli CA, Boakye M, Morton RA, et al. Recovery of Over-Ground Walking after Chronic Motor Complete Spinal Cord Injury. N Engl J Med. 2018;379:1244-50. Published 2018 Sept 24. DOI: 10.1056/NEJMoa1803588 Lu DC,

Edgerton VR, Modaber M, et al. Engaging Cervical Spinal Cord Networks to Reenable Volitional Control of Hand Function in Tetraplegic Patients. Neurorehabil Neural Repair. 2016;30(10):951–962. doi:10.1177/1545968316644344

Gerasimenko Y, Gorodnichev R, Puhov A, et al. Initiation and modulation of locomotor circuitry output with multisite transcutaneous electrical stimulation of the spinal cord in noninjured humans. J Neurophysiol. 2015;113:834-842.

Gerasimenko Y, Gorodnichev R, Moshonkina T, Sayenko D, Gad P, Reggie Edgerton V. Transcutaneous electrical spinal-cord stimulation in humans. Ann Phys Rehabil Med. 2015;58(4):225–231. doi:10.1016/j.rehab.2015.05.003

Gad P, Gerasimenko Y, Zdunowski S, et al. Weight bearing over-ground stepping in an exoskeleton with non-invasive spinal cord neuromodulation after motor complete paraplegia. Front Neuroci. 2017;11(333). doi: 10.3389/fnins.2017.00333

Hofstoetter US, McKay WB, Tansey KE, Mayr W, Kern H, Minassian K. Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury. J Spinal Cord Med. 2014;37(2):202–211. doi:10.1179/2045772313Y.0000000149

Hofstoetter US, Krenn M, Danner SM, et al. Augmentation of Locomotion by tSCS in Incomplete SCI. Artificial Organs. 2015;39: E176-E186. doi:10.1111/aor.12615

Inanici F, Samejima S, Gad P, Edgerton VR, Hofstetter CP, Moritz CT. Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2018;26(6):1272-1278. doi: 10.1109/TNSRE.2018.2834339

Gad P, Lee S, Terrafranca N, et al. Non-invasive activation of cervical spinal networks after severe paralysis. J Neurotrauma. 2018;35(18):2145-2158. doi: 10.1089/neu.2017.5461.