Restoring hand and arm function following spinal cord injury
Restoring hand and arm function is the highest treatment priority of individuals with cervical spinal cord injury (SCI). Traditional approaches of occupational or physical therapy do not provide sufficient specificity to target damaged neural networks and promote spared connections between the brain and periphery. Center investigators, led by Marcia O’Malley, PhD and Dimitry Sayenko, MD, PhD proposed that the simultaneous activation of descending commands with a coordinated engagement of spinal networks is a critical objective in neurorehabilitation. This novel multi-disciplinary approach that combines spinal neuromodulation and robotics will allow the center to target, for the first time, upper limb (UL) neurorehabilitation at different levels of the neuroaxis, including descending control, supraspinal and spinal sensorimotor networks, and sensory inputs. This study is designed to determine the effects of an intervention that combines transcutaneous electrical spinal cord stimulation (TSS) with rehabilitation training using an UL robotic exoskeleton on the neurophysiological and functional outcomes in individuals with incomplete cervical SCI. The team’s central hypothesis is that TSS will enhance the excitability of spinal sensorimotor networks below the SCI, while operating an exoskeleton will provide a robust valley of descending and sensory inputs converging on the pre-excited spinal circuitry, thus resulting in increased functional motor output and improved voluntary control of the UL movements. The goals are to: (1) demonstrate that the therapeutic effects of robotic training are superior in regaining motor function of UL when combined with spinal stimulation, compared with the training with Sham stimulation, and (2) elucidate the underlying mechanisms of this combined approach. (CHN: SCIRTS chn:wdg)
Funding: Craig H. Neilsen Foundation Grant ID Number: 733278
Oh, J., Steele, A. G., Varghese, B., Martin, C. A., Scheffler, M. S., Markley, R. L., … & Sayenko, D. G. (2022). Cervical transcutaneous spinal stimulation for spinal motor mapping. iScience, 25(10), 105037.
Mahan, E., Dunkelberger, N., Oh, J., Simmons, M., Varghese, B., Sayenko, D., and O’Malley, M. K. (2022) Measuring torque production with a robotic exoskeleton during cervical transcutaneous spinal stimulation. International Conference on Rehabilitation Robotics (ICORR), IEEE, pp. 1-5.
(Submitted) Mahan, E., Zook, G., King, S., Oh, J., Scheffler, M., Martin, C., Dinh, J., Sayenko, D., and O’Malley, M. K. (2023) An Upper Limb Robotic Exoskeleton for Dual Rehabilitation Interventions with Integrated Kinematic Assessment. International Conference on Rehabilitation Robotics (ICORR).