Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design.
Soshi Samejima, Charlotte D Caskey, Fatma Inanici and 7 others
PMID 35076067WHAT IT FOUND
Two men with incomplete cervical spinal cord injury walked three times farther when transcutaneous spinal stimulation was added to locomotor training.
Improvements in walking, balance, and bowel function lasted for months after the stimulation stopped.
Key findings
01Walking distance during the 6-Minute Walk Test increased threefold more during the stimulation phase compared with locomotor training alone.
02Both participants showed clinically meaningful improvements in bowel function, including reduced management time and normalized frequency for one participant.
03One participant was able to discontinue intermittent catheterization and reported no urinary tract infections since the study ended.
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
The study included only two participants, which limits generalizability and statistical power. There was no blinding or sham stimulation control, so placebo effects or the Hawthorne effect cannot be ruled out. The design did not directly compare lumbosacral stimulation alone versus combined cervical and lumbosacral stimulation, so the added value of the cervical component is unclear. Autonomic outcomes relied partly on anecdotal reports and caregiver observations rather than standardized clinical measures for bladder volume. Baseline stability was not fully established for all functional outcomes due to equipment availability issues for one participant.
Declared interests
The funders (National Science Foundation, Washington State Spinal Cord Injury Consortium, Christopher and Dana Reeve Foundation, University of Washington Institute for Neuroengineering, Washington Research Foundation) played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not conclude that transcutaneous spinal stimulation is the sole cause of the functional improvements. The study did not use a sham stimulation control group, so the observed gains could be due to the intensive locomotor training, placebo effects, or the combination of both. Additionally, improvements in spasticity were temporary and returned to baseline after stimulation stopped.