Non-invasive brain stimulation and robot-assisted gait training after incomplete spinal cord injury: A randomized pilot study

Article type: Research Article

Authors: Raithatha, Ravi^a | Carrico, Cheryl^b | Powell, Elizabeth Salmon^b | Westgate, Philip M.^c | Chelette II, Kenneth C.^b | Lee, Kara^d | Dunsmore, Laura^e | Salles, Sara^b | Sawaki, Lumy^{b; e; *}

Affiliations: [a] University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, KY, USA | [b] University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA | [c] University of Kentucky, Department of Biostatistics, College of Public Health, Lexington, KY, USA | [d] University of Kentucky College of Health Sciences, Lexington, KY, USA | [e] HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA

Correspondence: [*] Address for correspondence: Lumy Sawaki, MD, PhD, University of Kentucky, Department of Physical Medicine and Rehabilitation at HealthSouth Cardinal Hill Hospital, 2050 Versailles Road, Lexington, KY 40504, USA. Tel.: +1 859 323 6226; Fax: +1 859 323 1123; E-mail: lsawa2@uky.edu.

Abstract: BACKGROUND:Locomotor training with a robot-assisted gait orthosis (LT-RGO) and transcranial direct current stimulation (tDCS) are interventions that can significantly enhance motor performance after spinal cord injury (SCI). No studies have investigated whether combining these interventions enhances lower extremity motor function following SCI. OBJECTIVE:Determine whether active tDCS paired with LT-RGO improves lower extremity motor function more than a sham condition, in subjects with motor incomplete SCI. METHODS:Fifteen adults with SCI received 36 sessions of either active (n = 9) or sham (n = 6) tDCS (20 minutes) preceding LT-RGO (1 hour). Outcome measures included manual muscle testing (MMT; primary outcome measure); 6-Minute Walk Test (6MinWT); 10-Meter Walk Test (10MWT); Timed Up and Go Test (TUG); Berg Balance Scale (BBS); and Spinal Cord Independence Measure-III (SCIM-III). RESULTS:MMT showed significant improvements after active tDCS, with the most pronounced improvement in the right lower extremity. 10MWT, 6MinWT, and BBS showed improvement for both groups. TUG and SCIM-III showed improvement only for the sham tDCS group. CONCLUSION:Pairing tDCS with LT-RGO can improve lower extremity motor function more than LT-RGO alone. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.

Keywords: Lower extremity, motor function, neuroplasticity, treadmill training, transcranial direct current stimulation

DOI: 10.3233/NRE-151291

Journal: NeuroRehabilitation, vol. 38, no. 1, pp. 15-25, 2016