- Original article
- Open access
- Published:
The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury
Egyptian Rheumatology and Rehabilitation volume 46, pages 21–26 (2019)
Abstract
Background
Functional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI.
Purpose
Our randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs.
Patients and methods
Our study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential).
Conclusion
Our study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.
References
Muslumanoglu L, Aki S, Ozturk Y, Soy D, Filiz M, Karan A, Berker E. Motor, sensory and functional recovery in patients with spinal cord lesions. Spinal Cord 1997; 35:386–389
Miller RC. Neuromuscular restorative therapy: a therapeutic application of functional electric stimulation in individuals with spinal cord injury. Canada, Toronto: University Of Toronto; 2005
Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004; 21:1371–1383
Snoek GJ, MJ IJ, Hermens HJ, Maxwell D, Biering-Sorensen F. 2015 Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004; 42:526–532
Bareyre FM. Neuronal repair and replacement in spinal cord injury. J Neurol Sci 2008; 265:63–72
LynskeyJV, Belanger A, Jung R. Activity-dependent plasticity in spinal cord injury. J Rehabil Res Dev 2008 45:229–240
Raineteau O. Plastic responses to spinal cord injury. Behav Brain Res 2008; 192:114–123
Wang RY, Tseng HY, Liao KK, Wang CJ, Lai KL, Yang YR. rTMS combined with task-oriented training to improve symmetry of interhemispheric corticomotor excitability and gait performance after stroke: a randomized trial. Neurorehabil Neural Repair 2012 26:222–230
Popovic MR, Thrasher TA, Adams ME, Takes V, Zivanovic V, Tonack Ml. Functional electrical therapy: retraining grasping in spinal cord injury. Spinal Cord 2006 44:143–151
Popovic MR, Kapadia N, Zivanovic V, Furlan JC, Craven BC, McGillivray C. Functional electrical stimulation therapy of voluntary grasping versus only conventional rehabilitation for patients with subacute incomplete tetraplegia: a randomized clinical trial. Neurorehabil Neural Repair 2011 25:433–442
Rushton DN. Functional electrical stimulation and rehabilitation – an hypothesis. Med Eng Phys 2003; 25:75–78
Kaelin-Lang A, Sawaki L, Cohen LG. Role of voluntary drive in encoding an elementary motor memory. J Neurophysiol 2005 93:1099–1103
Blickenstorfer A, Kleiser R, Keller T, Keisker B, Meyer M, Riener R, Kollias S. Cortical and subcortical correlates of functional electrical stimulation of wrist extensor and flexor muscles revealed by fM Rl. Hum Brain Mapp 2009 30:963–975
Barsi Gl, Popovic DB, Tarkka IM, Sinkjaer T, Grey MJ. Cortical excitability changes following grasping exercise augmented with electrical stimulation. Exp Brain Res 2008 191:57–66
Belci M, Catley M, Husain M, Frankel HL, Davey NJ. Magnetic brain stimulation can improve clinical outcome in incomplete spinal cord injured patients. Spinal Cord 2004 42:417–419
Gomes-Osman J, Field-Fote EC. Improvements in hand function in adults with chronic tetraplegia following a multiday 10-Hz repetitive transcranial magnetic stimulation intervention combined with repetitive task practice. J Neurol Phys Ther 2015; 39:23–30
Kuppuswamy A, Balasubramaniam AV, Maksimovic R, et al. Action of 5 Hz repetitive transcranial magnetic stimulation on sensory, motor and autonomic function in human spinal cord injury. Clin Neurophysiol 2011; 122:2452–2461
Antal A, Nitsche MA, Kincses TZ, Kruse W, Hoffmann KP, Paulus W. Facilitation of visuo-motor learning by transcranial direct current stimulation of the motor and extrastriate visual areas in humans. Eur J Neurosci 2004 19:2888–2892
Stagg CJ, O’Shea J, Kincses ZT, Woolrich M, Matthews PM, Johansen-Berg H. Modulation of movement-associated cortical activation by transcranial direct current stimulation. Eur J Neurosci 2009 30:1412–1423
Herbison GJ, Isaac Z, Cohen ME, Ditunno JF Jr. Strength post-spinal cord injury: myometer vs manual muscle test. Spinal Cord 1996 34:543–548
Sisto SA, Dyson-Hudson T. Dynamometry testing in spinal cord injury. J Rehabil Res Dev 2007 44:123–136
Touge Gerschlager W, Brown P, Rothwell JC. Are the after-effects of low-frequency rTMS on motor cortex excitability due to changes in the efficacy of cortical synapses? Clin Neurophysiol 2001; 112:2138–2145
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Fawaz, S., Kamel, F., El Yasaky, A. et al. The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury. Egypt Rheumatol Rehabil 46, 21–26 (2019). https://doi.org/10.4103/err.err_48_18
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/err.err_48_18