Therapeutic Application of Functional Electrical Stimulation and Transcranial Magnetic Stimulation in Rehabilitation of Hand Function in Incomplete Cervical Spinal Cord Injury

Abstract

aumatic spinal cord injury (SCI) is a traumatic injury to the spinal cord, resulting in impairment of motor or sensory function or both (at and below level of injury), leading to paraplegia or tetraplegia and subsequently affecting the patient's quality of life. The most common site of injury is the cervical spinal cord. Injuries in this area are often most devastating as the extent of impairment and disability is greater than any other region of the body. In cervical SCI impaired arm and hand function impacts an individual’s ability in self-care, work and recreational activities. Many individuals with tetraplegia cite recovery of arm and hand function as the most important goal in rehabilitation.Hence comes the importance of improving hand function, in order to provide them with the highest level of independence. Recently, the central nervous system has shown a great ability to adapt and change itself in response to any injury or damage via a process termed plasticity, which involves reorganization of brain centers, unmasking of new synaptic connections and/or changes in neurotransmitter levels that affect its inhibitory or excitatory state. Rehabilitation of tetraplegic patients largely depends on improving these plastic changes. FES has long been shown to enhance these plastic changes. Recently non-invasive brain stimulation has been used as a tool to modulate activity of corticospinal, cortical, and subcortical pathways to promote functional recovery. The present study was carried out to compare between the two rehabilitation programs FES and rTMS versus FES alone, as regards hand function in chronic traumatic incomplete cervical SCI patients and to compare changes in cortical excitability between the two groups, and its relation to hand function before and after the rehabilitation programs. Our study was conducted on 22 patients with chronic traumatic incomplete SCI, Our patients were randomly assigned into two groups, each group included 11 patients. Patients were clinically assessed using ASIA score for grading and leveling patients, MRC scale and hand grip dynamometer for power assessment. Our functional assessment included FIM score for general assessment, hand scores as ARAT, mSHFT, nine hole peg board scale and finger tapping test. Our electrophysiological tests included MEP to abductor pollicis brevis, surface EMG assessing the activity during maximum voluntary contractions to the thenars, long flexors and extensor muscle groups and EPT to C8 dermatome.