Transcutaneous spinal cord simulation with novel electrode array improves walking in a patient with incomplete spinal cord injury

Research Objectives: To determine the safety, feasibility, and impact of transcutaneous spinal cord stimulation (TSS) via an electrode array

Design: Prospective, single case study

Setting: Hospital-based, outpatient SCI center

Participants: A 49-year-old man with chronic C4 AIS C, using a power wheelchair for primary mobility. He walked in therapy with platform walker and assist of two.

Interventions: 22 sessions of gait training with TSS. 90 minutes sessions, including 60 minutes of TSS. Interventions included lower extremity strengthening, functional transfers, static and dynamic standing balance, overground gait, and body weight supported treadmill training.

Main Outcome Measures: Adverse events, pain, and compliance were monitored for safety and feasibility. To explore changes in walking function, the Timed Up and Go (TUG), 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury II (WISCI II), and 6-Minute Walk Test (6MWT) were performed. Motor control was assessed via computer aided goniometry and electromyography, during a knee extension task. The. ISNCSCI was used to gain insight into participant’s neurological change.

Results: No adverse events were reported during the study. Pain was not a limiting factor. The participant demonstrated improvement in all walking measures: TUG (-16.44 seconds), 10 MWT with walker (+.16 m/s), 10 MWT with handheld assistance (+.18 m/s), and 6MWT with walker (+48.5 m). There were no significant changes in ISNCSCI or WISCI scores. The participant reported decreased assistance for gait and manual wheelchair mobility in the home and community, improved core stability, and increased lower extremity sensation.

Conclusions: Results indicate TSS with an electrode array is safe and feasible. This participant demonstrated improvements in walking speed, endurance, and quality. He generalized these gains to independent household ambulation and a manual wheelchair, propelled with his feet, for community mobility. Changes in upper extremity and trunk function yielded increased independence in ADLs, mobility, and transfers. These results warrant additional investigation in future, larger, controlled trials.

Author(s) Disclosures: Institutional research support was provided by the device manufacturer (Aneuvo) and managed by the institute's conflict of interest department. No personal financial or non-financial conflicts exist.