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Veith DD, Linde MB, Wiggins CC, Zhao KD, Garlanger KL. Intervention Design of High-Intensity Interval Training in Individuals With Spinal Cord Injury: Narrative Review and Future Perspectives. Top Spinal Cord Inj Rehabil 2023; 29:1-15. [PMID: 38076494 PMCID: PMC10704212 DOI: 10.46292/sci22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Individuals with spinal cord injury (SCI) have lower levels of physical activity compared to the nondisabled population. Exercise guidelines recommend moderate or vigorous exercise to improve cardiovascular health and reduce cardiometabolic risk factors in persons with SCI. High-intensity interval training (HIIT) is a popular exercise choice and encompasses brief periods of vigorous exercise paired with intermittent periods of recovery. Objectives This review describes the available literature on HIIT for individuals with SCI, including differences in protocol design and suggested areas of further investigation. Methods Our institution's library system performed the comprehensive search. The primary keywords and phrases used to search included spinal cord injury, high-intensity interval training, tetraplegia, paraplegia, and several other related terms. Results Initially 62 records were screened, and 36 were deemed outside the scope of this review. Twenty-six studies published between 2001 and 2021 fulfilled the eligibility criteria and were divided among two researchers for review and analysis. All records required persons with SCI and a standardized HIIT intervention. Study design varied widely with respect to mode of exercise, prescribed intensity, duration of performance intervals, and session duration. This variability necessitates further investigation into the specifics of a HIIT prescription and the associated outcomes for persons with SCI. Conclusion Standardization of HIIT protocols may lead to more robust conclusions regarding its effects on cardiorespiratory fitness as well as mitigation of cardiometabolic risk factors. Meta-analyses will eventually be needed on proper dosing and session parameters to improve cardiorespiratory fitness and cardiometabolic risk factors.
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Affiliation(s)
- Daniel D. Veith
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Margaux B. Linde
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Kristin L. Garlanger
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Linde MB, Webb KL, Veith DD, Morkeberg OH, Gill ML, Van Straaten MG, Laskowski ER, Joyner MJ, Beck LA, Zhao KD, Wiggins CC, Garlanger KL. At-Home High-Intensity Interval Training for Individuals with Paraplegia Following Spinal Cord Injury: A Pilot Study. medRxiv 2023:2023.06.21.23291711. [PMID: 37425869 PMCID: PMC10327239 DOI: 10.1101/2023.06.21.23291711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Objective This pilot study aimed to assess the efficacy of a 16-week at-home high-intensity interval training (HIIT) program among individuals with spinal cord injury (SCI). Methods Eight individuals (age: 47±11 (SD) years, 3 females) with SCI below the sixth thoracic vertebrae participated in a 16-week at-home HIIT program using an arm ergometer. Participants completed baseline graded exercise tests to determine target heart rate zones. HIIT was prescribed thrice per week. Each training session consisted of six one-minute bouts with a target heart rate ~80% heart rate reserve (HRR), interspersed with two minutes of recovery at ~30% HRR. A portable heart rate monitor and phone application provided visual feedback during training and allowed for measurements of adherence and compliance. Graded exercise tests were completed after 8 and 16 weeks of HIIT. Surveys were administered to assess participation, self-efficacy, and satisfaction. Results Participants demonstrated a decrease in submaximal cardiac output (P=0.028) and an increase in exercise capacity (peak power output, P=0.027) following HIIT, indicative of improved exercise economy and maximal work capacity. An 87% adherence rate was achieved during the HIIT program. Participants reached a high intensity of 70% HRR or greater during ~80% of intervals. The recovery HRR target was reached during only ~35% of intervals. Self-reported metrics of satisfaction and self-efficacy with at-home HIIT scored moderate to high. Conclusion Participants demonstrated an improvement in exercise economy and maximal work capacity following at-home HIIT. Additionally, participant adherence, compliance, satisfaction, and self-efficacy metrics suggest that at-home HIIT was easily implemented and enjoyable.
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Affiliation(s)
- Margaux B. Linde
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Kevin L. Webb
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Daniel D. Veith
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Olaf H. Morkeberg
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Megan L Gill
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Meegan G. Van Straaten
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Edward R. Laskowski
- Mayo Clinic, Department of Physical Medicine & Rehabilitation and Division of Sports Medicine, Department of Orthopedics, Rochester, MN
| | - Michael J. Joyner
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Lisa A. Beck
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Kristin D. Zhao
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Chad C. Wiggins
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Kristin L. Garlanger
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
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Webb KL, Veith DD, Linde MB, Miller AD, Morkeberg OH, Laskowski ER, Joyner MJ, Garlanger KL, Wiggins CC. Effects Of High-intensity Interval Training (HIIT) On Central Hemodynamics In Patients With Spinal Cord Injury. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876364.97326.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Linde MB, Thoreson AR, Lopez C, Gill ML, Veith DD, Hale RF, Calvert JS, Grahn PJ, Fautsch KJ, Sayenko DG, Zhao KD. Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors. Front Rehabilit Sci 2021; 2:757828. [PMID: 36188812 PMCID: PMC9397738 DOI: 10.3389/fresc.2021.757828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
Background: Neuromodulation using epidural electrical stimulation (EES) has shown functional restoration in humans with chronic spinal cord injury (SCI). EES during body weight supported treadmill training (BWSTT) enhanced stepping performance in clinical trial participants with paraplegia. Unfortunately, tools are lacking in availability to quantify clinician assistance during BWSTT with and without EES. Force sensitive resistors (FSRs) have previously quantified clinician assistance during static standing; however, dynamic tasks have not been addressed. Objective: To determine the validity of FSRs in measurements of force and duration to quantify clinician assistance and participant progression during BWSTT with EES in participants with SCI. Design: A feasibility study to determine the effectiveness of EES to restore function in individuals with SCI. Methods: Two male participants with chronic SCI were enrolled in a pilot phase clinical trial. Following implantation of an EES system in the lumbosacral spinal cord, both participants underwent 12 months of BWSTT with EES. At monthly intervals, FSRs were positioned on participants' knees to quantity forces applied by clinicians to achieve appropriate mechanics of stepping during BWSTT. The FSRs were validated on the benchtop using a leg model instrumented with a multiaxial load cell as the gold standard. The outcomes included clinician-applied force duration measured by FSR sensors and changes in applied forces indicating progression over the course of rehabilitation. Results: The force sensitive resistors validation revealed a proportional bias in their output. Loading required for maximal assist training exceeded the active range of the FSRs but were capable of capturing changes in clinician assist levels. The FSRs were also temporally responsive which increased utility for accurately assessing training contact time. The FSRs readings were able to capture independent stance for both participants by study end. There was minimal to no applied force bilaterally for participant 1 and unilaterally for participant 2. Conclusions: Clinician assistance applied at the knees as measured through FSRs during dynamic rehabilitation and EES (both on and off) effectively detected point of contact and duration of forces; however, it lacks accuracy of magnitude assessment. The reduced contact time measured through FSRs related to increased stance duration, which objectively identified independence in stepping during EES-enabled BWSTT following SCI.
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Affiliation(s)
- Margaux B. Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Megan L. Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Daniel D. Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena F. Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan S. Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peter J. Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kalli J. Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Kristin D. Zhao
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Calvert JS, Gill ML, Linde MB, Veith DD, Thoreson AR, Lopez C, Lee KH, Gerasimenko YP, Edgerton VR, Lavrov IA, Zhao KD, Grahn PJ, Sayenko DG. Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury. J Clin Med 2021; 10:jcm10214898. [PMID: 34768418 PMCID: PMC8584516 DOI: 10.3390/jcm10214898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/29/2022] Open
Abstract
Transcutaneous (TSS) and epidural spinal stimulation (ESS) are electrophysiological techniques that have been used to investigate the interactions between exogenous electrical stimuli and spinal sensorimotor networks that integrate descending motor signals with afferent inputs from the periphery during motor tasks such as standing and stepping. Recently, pilot-phase clinical trials using ESS and TSS have demonstrated restoration of motor functions that were previously lost due to spinal cord injury (SCI). However, the spinal network interactions that occur in response to TSS or ESS pulses with spared descending connections across the site of SCI have yet to be characterized. Therefore, we examined the effects of delivering TSS or ESS pulses to the lumbosacral spinal cord in nine individuals with chronic SCI. During low-frequency stimulation, participants were instructed to relax or attempt maximum voluntary contraction to perform full leg flexion while supine. We observed similar lower-extremity neuromusculature activation during TSS and ESS when performed in the same participants while instructed to relax. Interestingly, when participants were instructed to attempt lower-extremity muscle contractions, both TSS- and ESS-evoked motor responses were significantly inhibited across all muscles. Participants with clinically complete SCI tested with ESS and participants with clinically incomplete SCI tested with TSS demonstrated greater ability to modulate evoked responses than participants with motor complete SCI tested with TSS, although this was not statistically significant due to a low number of subjects in each subgroup. These results suggest that descending commands combined with spinal stimulation may increase activity of inhibitory interneuronal circuitry within spinal sensorimotor networks in individuals with SCI, which may be relevant in the context of regaining functional motor outcomes.
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Affiliation(s)
- Jonathan S. Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN 55905, USA;
| | - Megan L. Gill
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Margaux B. Linde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Daniel D. Veith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Andrew R. Thoreson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Cesar Lopez
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Kendall H. Lee
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Physiology and Biomedical Engineering, Rochester, MN 55905, USA
| | - Yury P. Gerasimenko
- Pavlov Institute of Physiology of Russian Academy of Sciences, 199034 St. Petersburg, Russia;
- Department of Physiology and Biophysics, University of Louisville, Louisville, KY 40292, USA
| | - Victor R. Edgerton
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA;
- Department of Neurobiology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari Adscrit a la Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo 2007, Australia
| | - Igor A. Lavrov
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Kristin D. Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
- Department of Physiology and Biomedical Engineering, Rochester, MN 55905, USA
| | - Peter J. Grahn
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Dimitry G. Sayenko
- Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-363-7949
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Gill ML, Linde MB, Hale RF, Lopez C, Fautsch KJ, Calvert JS, Veith DD, Beck LA, Garlanger KL, Sayenko DG, Lavrov IA, Thoreson AR, Grahn PJ, Zhao KD. Alterations of Spinal Epidural Stimulation-Enabled Stepping by Descending Intentional Motor Commands and Proprioceptive Inputs in Humans With Spinal Cord Injury. Front Syst Neurosci 2021; 14:590231. [PMID: 33584209 PMCID: PMC7875885 DOI: 10.3389/fnsys.2020.590231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Regaining control of movement following a spinal cord injury (SCI) requires utilization and/or functional reorganization of residual descending, and likely ascending, supraspinal sensorimotor pathways, which may be facilitated via task-specific training through body weight supported treadmill (BWST) training. Recently, epidural electrical stimulation (ES) combined with task-specific training demonstrated independence of standing and stepping functions in individuals with clinically complete SCI. The restoration of these functions may be dependent upon variables such as manipulation of proprioceptive input, ES parameter adjustments, and participant intent during step training. However, the impact of each variable on the degree of independence achieved during BWST stepping remains unknown. Objective: To describe the effects of descending intentional commands and proprioceptive inputs, specifically body weight support (BWS), on lower extremity motor activity and vertical ground reaction forces (vGRF) during ES-enabled BWST stepping in humans with chronic sensorimotor complete SCI. Furthermore, we describe perceived changes in the level of assistance provided by clinicians when intent and BWS are modified. Methods: Two individuals with chronic, mid thoracic, clinically complete SCI, enrolled in an IRB and FDA (IDE G150167) approved clinical trial. A 16-contact electrode array was implanted in the epidural space between the T11-L1 vertebral regions. Lower extremity motor output and vertical ground reaction forces were obtained during clinician-assisted ES-enabled treadmill stepping with BWS. Consecutive steps were achieved during various experimentally-controlled conditions, including intentional participation and varied BWS (60% and 20%) while ES parameters remain unchanged. Results: During ES-enabled BWST stepping, the knee extensors exhibited an increase in motor activation during trials in which stepping was passive compared to active or during trials in which 60% BWS was provided compared to 20% BWS. As a result of this increased motor activation, perceived clinician assistance increased during the transition from stance to swing. Intentional participation and 20% BWS resulted in timely and purposeful activation of the lower extremities muscles, which improved independence and decreased clinician assistance. Conclusion: Maximizing participant intention and optimizing proprioceptive inputs through BWS during ES-enabled BWST stepping may facilitate greater independence during BWST stepping for individuals with clinically complete SCI. Clinical Trial Registration:ClinicalTrials.gov identifier: NCT02592668.
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Affiliation(s)
- Megan L Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Margaux B Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena F Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kalli J Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Daniel D Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Lisa A Beck
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kristin L Garlanger
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Igor A Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Peter J Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States.,Office for Education Diversity, Equity and Inclusion, Mayo Clinic, Rochester, MN, United States
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Calvert JS, Grahn PJ, Strommen JA, Lavrov IA, Beck LA, Gill ML, Linde MB, Brown DA, Van Straaten MG, Veith DD, Lopez C, Sayenko DG, Gerasimenko YP, Edgerton VR, Zhao KD, Lee KH. Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis. J Neurotrauma 2018; 36:1451-1460. [PMID: 30430902 PMCID: PMC6482916 DOI: 10.1089/neu.2018.5921] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described. Herein, we describe the surgical and intraoperative electrophysiological approach used, followed by initial EES-enabled results observed in 2 human subjects with motor complete paralysis who were enrolled in a clinical trial investigating the use of EES to enable motor functions after SCI. The 16-contact electrode array was initially positioned under fluoroscopic guidance. Then, EES-evoked motor responses were recorded from select leg muscles and displayed in real time to determine electrode array proximity to spinal cord regions associated with motor activity of the lower extremities. Acceptable array positioning was determined based on achievement of selective proximal or distal leg muscle activity, as well as bilateral muscle activation. Motor response latencies were not significantly different between intraoperative recordings and post-operative recordings, indicating that array positioning remained stable. Additionally, EES enabled intentional control of step-like activity in both subjects within the first 5 days of testing. These results suggest that the use of EES-evoked motor responses may guide intraoperative positioning of epidural electrodes to target spinal cord circuitry to enable motor functions after SCI.
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Affiliation(s)
- Jonathan S Calvert
- 1 Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Peter J Grahn
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey A Strommen
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Igor A Lavrov
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lisa A Beck
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Megan L Gill
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Margaux B Linde
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Desmond A Brown
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Meegan G Van Straaten
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Daniel D Veith
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Dimitry G Sayenko
- 4 Department of Integrative Biology and Physiology University of California Los Angeles, Los Angeles, California.,12 Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, Texas
| | - Yury P Gerasimenko
- 4 Department of Integrative Biology and Physiology University of California Los Angeles, Los Angeles, California.,5 Pavlov Institute of Physiology, St. Petersburg, Russia
| | - V Reggie Edgerton
- 4 Department of Integrative Biology and Physiology University of California Los Angeles, Los Angeles, California.,6 Department of Neurobiology, University of California Los Angeles, Los Angeles, California.,7 Department of Neurosurgery, University of California Los Angeles, Los Angeles, California.,8 Brain Research Institute, University of California Los Angeles, Los Angeles, California.,9 Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain.,10 Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kristin D Zhao
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota.,11 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Kendall H Lee
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota.,11 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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