Engaging Cervical Spinal Cord Networks to Reenable Volitional Control of Hand Function in Tetraplegic Patients.
Daniel C Lu, V Reggie Edgerton, Morteza Modaber and 8 others
PMID 27198185WHAT IT FOUND
Two people with chronic cervical spinal cord injury showed greater grip force and hand control during cervical epidural stimulation, and over repeated sessions.
This is not evidence the stimulation works for other patients.
Key findings
01In two chronic cervical spinal cord injury subjects, average maximum grip force, squeeze-release repetitions, and tracking accuracy increased during cervical epidural stimulation sessions.
02Subject 1 showed long-lasting grip force improvement over 8 testing sessions or 8 weeks, and Subject 2 showed improvement over 7 testing sessions or 1 week.
03Both subjects' ARAT scores increased by 20% (6.0 points), above the 5.7-point responsiveness threshold for that instrument.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only two subjects were studied, so the findings cannot be generalised to other people with tetraplegia. There was no separate control group, and subjects were not truly blinded to stimulation. The implant was placed to treat chronic pain, and motor stimulation was added during testing sessions, so the contribution of stimulation alone cannot be separated from repeated testing and practice. Subject 1 was tested after permanent implantation, while Subject 2 was tested with a temporary implant and was awaiting a permanent implant. Only a fraction of possible electrode combinations, frequencies, intensities, and pulse widths were tested. The study had no established endpoint for termination. The subjects were more than 18 months beyond their initial injuries and had stable baseline function for four months, but this still does not show what happens in a larger group.
Declared interests
No author conflict of interest or funding declaration is provided. The publication types list non-U.S. government and NIH extramural support.
The easy way to misread this
Do not conclude that cervical epidural stimulation restores hand function in tetraplegic patients. Only two subjects were studied, there was no separate control group, and the implant was placed for pain, with repeated testing during sessions.