Author: Tharu, Niraj Singh
Title: Trans-spinal electrical stimulation for improving trunk and sitting function in tetraplegics with cervical cord injury
Advisors: Zheng, Yongping (BME)
Degree: M.Phil.
Year: 2023
Subject: Spinal cord -- Wounds and injuries -- Treatment
Cervical vertebrae -- Wounds and injuries -- Treatment
Electric stimulation
Hong Kong Polytechnic University -- Dissertations
Department: Department of Biomedical Engineering
Pages: xv, 116 pages : color illustrations
Language: English
Abstract: The aim of this study was to examine the efficacy of trans-spinal electrical stimulation (tsES) for improving trunk control and sitting stability with task-specific rehabilitation (tsR) in people with chronic tetraplegia. Five individuals with complete (AIS-A) cervical (C4-C7) spinal cord injury were enrolled in a 32-week clinical study. This was a longitudinal cohort study, where the combined intervention of tsES and tsR was given for 12 weeks, followed by tsR alone for another 12 weeks. The stimulating sites were T11 and L1, and the electrical stimulation frequency was from 20-30 Hz with 0.1-1 ms pulse width biphasic stimulation. The functional outcome scales used were the Modified Functional Reach Test (mFRT), Trunk Control Test (TCT), Function in Sitting Test (FIST), and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Moreover, the kinesiologic and electrophysiologic assessments were conducted through electromyography (EMG) and the Vicon motion capture system, followed by the assessment using 3D ultrasound imaging. The results showed that the tsES+tsR intervention improved forward reach distance from 2.0 ± 1.58 cm to 12.3 ± 6.12 cm (p = 0.02), right lateral reach distance from 0.9 ± 0.74 cm to 4.6 ± 2.58 cm (p = 0.03), and left lateral reach distance from 1.0 ± 0.79 cm to 4.0 ± 1.69 cm (p = 0.01), respectively. Meanwhile, the TCT and FIST scores increased from 3.0 ± 0.70 to 11.6 ± 3.36 (p < 0.01) and from 12.6 ± 4.45 to 29.0 ± 8.80 (p < 0.01), respectively after tsES+tsR. In addition, motion analysis results demonstrated an increased trunk range of motion: the flexion increased from 12.2 ± 4.71° to 23.1 ± 9.0° (p = 0.01); extension from 5.7 ± 2.04° to 12.4 ± 4.48° (p = 0.01); right lateral flexion from 5.8 ± 5.63° to 9.1 ± 5.43° (p = 0.04); left lateral flexion from 6.0 ± 2.82° to 9.8 ± 2.94° (p < 0.001); right rotation from 1.7 ± 2.30° to 4.5 ± 2.67° (p = 0.01); and left rotation from 18.4 ± 13.15° to 39.6 ± 13.43° (p < 0.01), respectively. Moreover, the EMG responses were highly elevated for latissimus dorsi (LD) muscle during extension after tsES+tsR: right LD increased from 2.20 ± 1.60 μV to 8.86 ± 6.04 μV and left LD from 2.57 ± 1.81 μV to 9.94 ± 6.70 μV, whereas, for erector spinae (ES): right ES increased from 1.62 ± 0.95 μV to 6.93 ± 6.32 μV and left ES from 1.79 ± 1.25 μV to 7.53 ± 5.47 μV, respectively. Additionally, right external oblique (EO) demonstrated greater response during right rotation, the value increased from 1.75 ± 1.31 μV to 6.15 ± 4.83 μV; while left EO revealed higher response during left rotation: from 2.07 ± 1.17 μV to 13.47 ± 7.49 μV. The ultrasound imaging of the sagittal spinal curvature revealed decreased thoracic kyphosis (pre-26.6 ± 7.3°, post-16.3 ± 5.0°) and increased lumbar lordosis (pre-9.3 ± 13.9°, post-11.7 ± 8.3°). It was also found that, functional gains were maintained after the follow-up period, demonstrating long-term effects of the intervention. The findings of this study showed that the tsES+tsR intervention improved independent trunk control with increased static and dynamic sitting balance, as well as the ability to perform upper-limb activities and functional tasks while sitting.
Rights: All rights reserved
Access: open access

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