title: Transvertebral direct current stimulation paired with locomotor training in chronic spinal cord injury: A case study.
abstract: METHODS
  This double-blind, sham-controlled, crossover case study combined transvertebral direct current stimulation (tvDCS) and locomotor training on a robot-assisted gait orthosis (LT-RGO).
  
  
  OBJECTIVE
  Determine whether cathodal tvDCS paired with LT-RGO leads to greater changes in function and neuroplasticity than sham tvDCS paired with LT-RGO.
  
  
  METHODS
  University of Kentucky (UK) HealthCare Stroke and Spinal Cord Neurorehabilitation Research at HealthSouth Cardinal Hill Hospital.
  
  
  METHODS
  A single subject with motor incomplete spinal cord injury (SCI) participated in 24 sessions of sham tvDCS paired with LT-RGO before crossover to 24 sessions of cathodal tvDCS paired with LT-RGO. Functional outcomes were measured with 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Spinal Cord Independence Measure-III (SCIM-III) mobility component, lower extremity manual muscle test (MMT), and Berg Balance Scale (BBS). Corticospinal changes were assessed using transcranial magnetic stimulation.
  
  
  RESULTS
  Improvement in 10MWT speed, SCIM-III mobility component, and BBS occurred with both conditions. 6MWT worsened after sham tvDCS and improved after cathodal tvDCS. MMT scores for both lower extremities improved following sham tvDCS but decreased following cathodal tvDCS. Corticospinal excitability increased following cathodal tvDCS but not sham tvDCS.
  
  
  CONCLUSIONS
  These results suggest that combining cathodal tvDCS and LT-RGO may improve functional outcomes, increase corticospinal excitability, and possibly decrease spasticity. Randomized controlled trials are needed to confirm these conclusions.
  
  
  BACKGROUND
  This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117, and the HealthSouth Cardinal Hill Stroke and Spinal Cord Endowment (1215375670).
authors.affiliation: University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.
authors.forename: Elizabeth Salmon
authors.initials: ES
authors.lastname: Powell
authors.affiliation: University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carrico
authors.affiliation: University of Pikeville Kentucky College of Medicine, Pikeville, KY, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Raithatha
authors.affiliation: University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Salyers
authors.affiliation: University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ward
authors.affiliation: University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.|HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA.
authors.forename: Lumy
authors.initials: L
authors.lastname: Sawaki
mesh_terms: D001915:Braces; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D000066530:Neurological Rehabilitation / Q000379:methods; D009989:Orthotic Devices; D026741:Physical Therapy Modalities; D012371:Robotics / Q000379:methods*; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000379:methods*
keywords: Neuromodulation; lower extremity; motor function; neuroplasticity; transcutaneous spinal direct current stimulation; treadmill training