Paired associative stimulation for spinal cord injury rehabilitation : a case study
The purpose of this study was to replicate a paired associative stimulation (PAS) therapeutic
intervention to improve the motor output in one tetraplegic individual’s hands. PAS is a paired
brain and nerve stimulation method using transcranial magnetic stimulation (TMS) and
peripheral nerve stimulation (PNS). Tetraplegia is a neurological injury to the spinal cord which
hinders voluntary movement of upper and lower limbs, with varying degrees based on the level
of the spinal cord which is severed. Utilizing a PAS protocol aims to target the neuroplasticity
in the CST to improve motor function.
The intervention was given for 6 weeks, with a total of 22 individual sessions. This intervention
tested the clinical feasibility of a high PAS protocol, as it used slightly altered stimulation
conditions compared to the original protocol. Physiotherapy assessments were conducted pre-,
post-, and 1-month post-intervention. This was the main evaluation method to assess functional
motor improvement in the hands. Average motor evoked potentials (MEPs) recordings were
also measured using TMS at pre- and post-intervention.
After 6 weeks of PAS therapy, functional motor output increased in both hands, which had been
diminished due to the injury. In the left hand, all the stimulated muscles saw improvement in
the functional measures (physiotherapy assessments). In the right hand, only two of the three
stimulated muscles saw minor improvements (extensor digitorum and abductor pollicis brevis),
due to the lack of visible MEPs, measured by the TMS, in the abductor pollicis brevis and the
abductor digiti minimi.
To conclude, the original PAS protocol was successfully modified to yield positive results.
Further studies should be conducted in the future for a longer duration to validate the clinical
feasibility.
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