Welcome to SCI Line

We are excited for another issue of the SCI Line, a newsletter for spinal cord injury (SCI) clinicians. We want to share recent and relevant content on SCI research, practice, and clinical resources amongst clinicians in the Canadian Spinal Cord Injury Clinician Directory. Our hope is that the newsletter will support awareness of SCI-related activities. We have added a new ‘Fun Fact’ section to the newsletter in hopes of sharing some smiles as well.
 
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Thank you,
 
The Rick Hansen Institute Clinical Team,
Kris (PT) & Tova (PT)

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Can transcutaneous spinal cord stimulation improve voluntary hand control in chronic, severe cervical SCI?

Data from this study show that transcutaneous stimulation along the midline of the cervical spinal column can change the state of the nonfunctional cervical neural networks to improve functional potential and allow increased voluntary upper limb function in individuals paralyzed up to 20+ years. Some theories about this treatment believe that it bypasses the site of injury by using interneurons to get the message to previously unreachable muscles. Stimulation parameters were designed to avoid directly inducing muscular contractions and instead, facilitate voluntary task performance. This means that the stimulation was meant to act as an “amplifier” of the signal coming from the brain, not cause muscle movements by itself.
 
Stimulation, combined with targeted training tasks for 8 treatment sessions led to a 225% increase in grip strength measured with the stimulation turned off and 325% increase with the stimulation on. After treatment, all 8 subjects showed decreased use of upper arm muscles and increased forearm muscle use when gripping. Additional improvements below the level of stimulation were reported by some individuals during the study including sensation below the level of lesion, trunk control, and bladder and bowel control.
 
As this study was designed to determine proof of concept and feasibility to use this type of stimulation to neuromodulate the cervical spinal segments to improve upper limb function, further investigation is needed before it is made available for general clinical use.

See pre and post treatment videos.

Read the full article

Kristen Walden, SCI PT:

“Spinal stimulation research and the concept of being able to up-regulate the neural circuitry to then be able to use functional task training with a much greater impact is very exciting. This would allow us to target neuro recovery goals for many more of our acute and chronic clients as it seems to show functional impacts even long after the injury. The article makes me think about the untapped potential of clients whom I have previously been treating with a compensation strategy focus as I considered them to be outside the window for neural plasticity.

There has been a lot of recent excitement about the potential for functional recovery using epidural spinal stimulation, but like many interventions being researched, it would be challenging to implement in a clinical setting so our patients could access it. Though this article is limited to proof of concept, it is exciting as the transcutaneous stimulation used is something non-invasive that could easily be integrated into a clinical rehab setting.

I am eager to see where the research leads in this area as there are many things still to be determined around optimal timing, frequency, intensity, etc.”

Two-way repeated measures analysis of variance (ANOVA)

ASCIP Clinical Webinars

ISNCSCI Algorithm

Spinal Cord Injury Massive Open Online Courses (SCIMOOC)

[COURSE] Evaluation and Treatment of Respiratory Function in Neurological Disorders on Current Best Practice