Eccentric Motor Training with Neuromodulation and Biomarkers for Rehabilitation Readiness in Subacute SCI
Abstract
Spinal cord injury (SCI) results in severe consequences, even if the injury is incomplete. War-related SCI occurs more frequently in younger people, with greater severity and with likelihood of additional associated trauma, making recovery of function more challenging and rehabilitation more difficult. Two interventions that show promise to help improve function but have never been tried together are nerve stimulation and downhill treadmill training. Downhill walking makes muscles work in a different way, called eccentric control. An example of eccentric control is lowering a raised barbell until your elbow is straight. Nerve and muscle stimulation activates the muscle to different degrees and, with specific parameters, increases activation more than would otherwise be possible for someone with SCI. Separately, eccentric training for locomotion on a downslope treadmill produces 21% greater neuromuscular activation than traditional treadmill training. Nerve and muscle stimulation produces 6%-80% gain when little improvement was expected. The expectation is that combining these two treatments together will bring improvements beyond what each can deliver alone. Still, effective therapies do not ensure recovery. Early after SCI, the environment within the spinal cord is toxic and is unable to function to full effect. Interventions delivered too early actually interfere rather than assist recovery, based on pre-clinical studies. Therefore, we propose to investigate genetic and imaging biomarkers as Go/No Go thresholds to determine readiness for rehabilitation. A No Go indicator will be the expression of genes from cerebrospinal fluid that show the spinal cord environment is inflammatory, a condition which makes rehabilitation less effective. For an image-based Go biomarker, we will quantify the amount of myelin around the nerve cells in the brain and spinal cord using magnetic resonance imaging. If lower levels of myelin are found, rehabilitation will be started immediately to avoid additional losses. This study will be started at 3 months after SCI, a period when we predict that inflammation will be declining (i.e., not too early) and myelin loss may still be limited (i.e., not too late). We will compare individuals with complete or incomplete SCI (neurologic level C4-T10) with age-matched, healthy controls.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110946
Entities
People
- D. Michele Basso
Organizations
- Ohio State University
- United States Army