Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury

Transcutaneous (TSS) and epidural spinal stimulation (ESS) are electrophysiological techniques that have been used to investigate the interactions between exogenous electrical stimuli and spinal sensorimotor networks that integrate descending motor signals with afferent inputs from the periphery dur...

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Autores principales:	Jonathan S. Calvert, Megan L. Gill, Margaux B. Linde, Daniel D. Veith, Andrew R. Thoreson, Cesar Lopez, Kendall H. Lee, Yury P. Gerasimenko, Victor R. Edgerton, Igor A. Lavrov, Kristin D. Zhao, Peter J. Grahn, Dimitry G. Sayenko
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	spinal cord injury electrically evoked spinal motor potentials spinal cord stimulation neuromodulation Medicine R
Acceso en línea:	https://doaj.org/article/4f7bbaeb51484266b562b5b45935314d
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spelling	oai:doaj.org-article:4f7bbaeb51484266b562b5b45935314d2021-11-11T17:32:53ZVoluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury10.3390/jcm102148982077-0383https://doaj.org/article/4f7bbaeb51484266b562b5b45935314d2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4898https://doaj.org/toc/2077-0383Transcutaneous (TSS) and epidural spinal stimulation (ESS) are electrophysiological techniques that have been used to investigate the interactions between exogenous electrical stimuli and spinal sensorimotor networks that integrate descending motor signals with afferent inputs from the periphery during motor tasks such as standing and stepping. Recently, pilot-phase clinical trials using ESS and TSS have demonstrated restoration of motor functions that were previously lost due to spinal cord injury (SCI). However, the spinal network interactions that occur in response to TSS or ESS pulses with spared descending connections across the site of SCI have yet to be characterized. Therefore, we examined the effects of delivering TSS or ESS pulses to the lumbosacral spinal cord in nine individuals with chronic SCI. During low-frequency stimulation, participants were instructed to relax or attempt maximum voluntary contraction to perform full leg flexion while supine. We observed similar lower-extremity neuromusculature activation during TSS and ESS when performed in the same participants while instructed to relax. Interestingly, when participants were instructed to attempt lower-extremity muscle contractions, both TSS- and ESS-evoked motor responses were significantly inhibited across all muscles. Participants with clinically complete SCI tested with ESS and participants with clinically incomplete SCI tested with TSS demonstrated greater ability to modulate evoked responses than participants with motor complete SCI tested with TSS, although this was not statistically significant due to a low number of subjects in each subgroup. These results suggest that descending commands combined with spinal stimulation may increase activity of inhibitory interneuronal circuitry within spinal sensorimotor networks in individuals with SCI, which may be relevant in the context of regaining functional motor outcomes.Jonathan S. CalvertMegan L. GillMargaux B. LindeDaniel D. VeithAndrew R. ThoresonCesar LopezKendall H. LeeYury P. GerasimenkoVictor R. EdgertonIgor A. LavrovKristin D. ZhaoPeter J. GrahnDimitry G. SayenkoMDPI AGarticlespinal cord injuryelectrically evoked spinal motor potentialsspinal cord stimulationneuromodulationMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4898, p 4898 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	spinal cord injury electrically evoked spinal motor potentials spinal cord stimulation neuromodulation Medicine R
spellingShingle	spinal cord injury electrically evoked spinal motor potentials spinal cord stimulation neuromodulation Medicine R Jonathan S. Calvert Megan L. Gill Margaux B. Linde Daniel D. Veith Andrew R. Thoreson Cesar Lopez Kendall H. Lee Yury P. Gerasimenko Victor R. Edgerton Igor A. Lavrov Kristin D. Zhao Peter J. Grahn Dimitry G. Sayenko Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury
description	Transcutaneous (TSS) and epidural spinal stimulation (ESS) are electrophysiological techniques that have been used to investigate the interactions between exogenous electrical stimuli and spinal sensorimotor networks that integrate descending motor signals with afferent inputs from the periphery during motor tasks such as standing and stepping. Recently, pilot-phase clinical trials using ESS and TSS have demonstrated restoration of motor functions that were previously lost due to spinal cord injury (SCI). However, the spinal network interactions that occur in response to TSS or ESS pulses with spared descending connections across the site of SCI have yet to be characterized. Therefore, we examined the effects of delivering TSS or ESS pulses to the lumbosacral spinal cord in nine individuals with chronic SCI. During low-frequency stimulation, participants were instructed to relax or attempt maximum voluntary contraction to perform full leg flexion while supine. We observed similar lower-extremity neuromusculature activation during TSS and ESS when performed in the same participants while instructed to relax. Interestingly, when participants were instructed to attempt lower-extremity muscle contractions, both TSS- and ESS-evoked motor responses were significantly inhibited across all muscles. Participants with clinically complete SCI tested with ESS and participants with clinically incomplete SCI tested with TSS demonstrated greater ability to modulate evoked responses than participants with motor complete SCI tested with TSS, although this was not statistically significant due to a low number of subjects in each subgroup. These results suggest that descending commands combined with spinal stimulation may increase activity of inhibitory interneuronal circuitry within spinal sensorimotor networks in individuals with SCI, which may be relevant in the context of regaining functional motor outcomes.
format	article
author	Jonathan S. Calvert Megan L. Gill Margaux B. Linde Daniel D. Veith Andrew R. Thoreson Cesar Lopez Kendall H. Lee Yury P. Gerasimenko Victor R. Edgerton Igor A. Lavrov Kristin D. Zhao Peter J. Grahn Dimitry G. Sayenko
author_facet	Jonathan S. Calvert Megan L. Gill Margaux B. Linde Daniel D. Veith Andrew R. Thoreson Cesar Lopez Kendall H. Lee Yury P. Gerasimenko Victor R. Edgerton Igor A. Lavrov Kristin D. Zhao Peter J. Grahn Dimitry G. Sayenko
author_sort	Jonathan S. Calvert
title	Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury
title_short	Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury
title_full	Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury
title_fullStr	Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury
title_full_unstemmed	Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury
title_sort	voluntary modulation of evoked responses generated by epidural and transcutaneous spinal stimulation in humans with spinal cord injury
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/4f7bbaeb51484266b562b5b45935314d
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Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury

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