Life Sciences - Linking Research and Patients' Needs Augmentation of residual neural control by non-invasive spinal cord stimulation to modify spasticity in spinal cord injured people

01.08.2011 - 31.07.2015
Forschungsförderungsprojekt
Spasticity is a feature of the upper motor neuron syndrome. As a major cause of disability after spinal cord injury (SCI) it involves muscle hypertonus, hyperreflexia, clonus, and involuntary muscle contractions. Irradiation of voluntarily initiated movement can diminish the functional utility of residual voluntary motor control. The pathophysiology of spasticity following SCI results from alterations of supraspinal drive, leading to reorganization of spinal cord circuitries and abnormal intraspinal processing of primary afferent input. Despite its high prevalence, effective management of spasticity is difficult. Physiotherapy predominantly acts on the biomechanical component of spasticity. Pharmacological agents block spinal neural activity in individuals who already have a reduced voluntary drive. Surgical procedures with potential loss of function are irreversible. Neuromodulation techniques, modifying altered input-output relations of neural circuitries by stimulation, appear as favourable alternatives. Epidural spinal cord stimulation (SCS) reduces severe lower limb spasticity in SCI persons, when targeting the upper lumbar cord. Over the last decade epidural stimulation of the lumbar spinal cord has been increasingly recognized to facilitate locomotion after SCI. Recent developments of a novel non-invasive, transcutaneous SCS technique and observa- tions from preliminary clinical tests motivated the proposed project. We will explore its application as a neuroaugmentative rehabilitation tool for spasticity control in SCI. We hypothesize that applying a tonic drive to the lumbar cord can transform neural circuits involved in the control of muscle tone and movement into more functional states and that beneficial post-stimulation effects will persist for some time. We will study the interaction of tonic transcutaneous SCS with different SCI profiles of participants with motor complete and incomplete lesions. Clinical, functional and neurophsyiological methods will assess different manifestations of spasticity and residual motor control capacities before and after continuous transcutaneous SCS (applied for 30 minutes). The persistence of the therapeutic effects will be identified, both carry-over effects after single application als well als plasticity with repetitive exposure to the intervention. In parallel, novel electrophysiologial methods based on the non-invasive elicitation of multi-segmental spinal reflexes shall be explored to assess spasticity and uncover its underlying integrated mechanisms. As a non-invasive, simple and cost-effective technique, transcutaneous SCS has great potential to be widely applied for modification of spasticity and residual motor control after SCI as well as neurophysiological studies. The planned co-operation of partners with complementary expertise encourages new approaches and opens a new interdisciplinary field for students to be trained in human neurosciences integrated into a patient-relevant programme.

Personen

Projektleiter_in

Projektmitarbeiter_innen

Institut

Grant funds

  • WWTF Wiener Wissenschafts-, Forschu und Technologiefonds (National) Vienna Science and Technology Fund (WWTF)

Forschungsschwerpunkte

  • Beyond TUW-research focus: 85%
  • Modeling and Simulation: 15%

Schlagwörter

DeutschEnglisch
Rückenmarkstimulationspinal cord stimulation
Elektrostimulationelectrostimulation
Nicht invasivnon-invasive
Spastizitätspasticity
Neuromodulationneuromodulation

Publikationen