Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury

Tele-rehabilitation using transcranial direct current stimulation combined with exercise in people with spinal cord injury: a randomized controlled trial

OBJECTIVE

This study explored the effects of home-based transcranial direct current stimulation combined with exercise on motor and sensory function, spasticity, functional and transfer performance, and quality of life.

DESIGN

A prospective, double-blind, randomized, sham-controlled trial.

SUBJECTS AND METHODS

Thirty individuals with SCI were allocated to receive either active transcranial direct current stimulation or sham transcranial direct current stimulation, followed by the same tele-rehabilitation programme, for 12 sessions over 4 weeks (3 sessions/week). Each session included 20 min of transcranial direct current stimulation followed by 1 h of tele-supervised exercise. Primary outcome was the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Secondary outcomes included (i) the upper limb muscle strength evaluated by hand-held dynamometer, (ii) spasticity evaluated by H reflex and modified-Modified Ashworth Scale, (iii) functional performance assessed by the spinal cord independence measure III, (iv) transfer performance assessed by the transfer assessment instrument, and (v) quality of life assessed by WHOQOL-BREF. Outcomes were assessed at baseline, post-intervention, and 1-month follow-up.

RESULTS

Two-way mixed ANOVA revealed an interaction effects between group and time (F(1,18)=4.49, p=0.043) and main effects of time (F(1,18)=7.82, p=0.009). Bonferroni post-hoc analysis showed a significant improvement only within the active group at 1-month follow-up (p=0.002) for the upper extremity motor scores (UEMS). No significant differences were observed for any of the secondary outcomes.

CONCLUSION

The effect of 12 sessions of home-based transcranial direct current stimulation combined with exercise was limited to improved upper limb motor recovery, with after-effect at 1-month post-intervention as compared with exercise alone. No improvements were found in sensory function, spasticity, functional and transfer performance, and quality of life. However, this intervention appeared to be feasible, safe, and well-adhered to and provides insight into the use of transcranial direct current stimulation as a tool for tele-rehabilitation in a spinal cord injury outpatient population.

Effects of Whole-Body Vibration on Ankle Control and Walking Speed in Individuals with Incomplete Spinal Cord Injury

BACKGROUND/OBJECTIVES

After spinal cord injury (SCI), poor dorsiflexor control and involuntary plantar-flexor contraction impair walking. As whole-body vibration (WBV) improves voluntary muscle activation and modulates reflex excitability, it may improve ankle control. In this study, the dosage effects of WBV on walking speed, dorsiflexion, and spinal reflex excitability were examined.

METHODS

Sixteen people with chronic motor-incomplete SCI participated in this randomized sham-control wash-in study. Two weeks of sham stimulation (wash-in phase) were followed by either 2 weeks of eight repetitions (short bout) or sixteen repetitions of WBV (long bout; intervention phase) per session. Walking speed, ankle angle at mid-swing, and low-frequency depression of the soleus H-reflex were measured before and after the wash-in phase and before and after the intervention phase.

RESULTS

A significant dosage effect of WBV was not observed on any of the measures of interest. There were no between-phase or within-phase differences in ankle angle during the swing phase or in low-frequency depression. When dosage groups were pooled together, there was a significant change in walking speed during the intervention phase (mean = 0.04 m/s, standard deviation = 0.06, p = 0.02). There was not a significant correlation between overall change in walking speed and dorsiflexion angle or low-frequency depression during the study.

CONCLUSIONS

Whole-body vibration did not have a dosage-dependent effect on dorsiflexion during the swing phase or on spinal reflex excitability. Future studies assessing the role of corticospinal tract (CST) descending drive on increased dorsiflexor ability and walking speed are warranted.

Research Progress on Treating Spinal Cord Injury by Modulating the Phenotype of Microglia

Spinal cord injury (SCI) is a severe central nervous system disorder with no currently available effective treatment. Microglia are immune cells in the central nervous system that play crucial roles in the SCI occurrence, development, and recovery stages. They exhibit dynamic polarization over time and can switch between classical activation (M1) and alternative activation (M2) phenotypes to respond to environmental stimuli. The M1 phenotype is involved in initiating and sustaining inflammatory responses, while the M2 phenotype exerts anti-inflammatory effects and promotes tissue repair in damaged areas. Inhibiting M1 polarization and promoting M2 polarization have become hotspots in regulating neuroinflammation and treating SCI. This article provides a comprehensive review centered on modulating microglial polarization phenotypes for SCI treatment.