title: Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: A proof of concept sham-randomized clinical study.
abstract: BACKGROUND
  After cervical spinal cord injury, current options for treatment of upper extremity motor functions have been limited to traditional approaches. However, there is a substantial need to explore more rigorous alternative treatments to facilitate motor recovery.
  
  
  OBJECTIVE
  To demonstrate whether anodal-primary motor cortex (M1) excitability enhancement (with cathodal-supra orbital area) (atDCS) combined with robot-assisted arm training (R-AAT) will provide greater improvement in contralateral arm and hand motor functions compared to sham stimulation (stDCS) and R-AAT in patients with chronic, incomplete cervical spinal cord injury (iCSCI).
  
  
  METHODS
  In this parallel-group, double-blinded, randomized and sham-controlled trial, nine participants with chronic iCSCI (AIS C and D level) were randomized to receive 10 sessions of atDCS or stDSC combined with R-AAT. Feasibility and tolerability was assessed with attrition rate and occurrence of adverse events, Changes in arm and hand function were assessed with Jebson Taylor Hand Function Test (JTHFT). Amount of Use Scale of Motor Activity Log (AOU-MAL), American Spinal Injury Association Upper Extremity Motor Score and Modified Ashworth Scale (MAS) at baseline, after treatment, and at two-month follow-up.
  
  
  RESULTS
  None of the participants missed a treatment session or dropped-out due to adverse events related to the treatment protocol. Participants tended to perform better in JTHFT and AOU-MAL after treatment. Active group at post-treatment and two-month follow-up demonstrated better arm and hand performance compared to sham group.
  
  
  CONCLUSIONS
  These preliminary findings support that modulating excitatory input of the corticospinal tracts on spinal circuits may be a promising strategy in improving arm and hand functions in persons with incomplete tetraplegia. Further study is needed to explore the underlying mechanisms of recovery.
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Nuray
authors: N
authors: Yozbatiran
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Zafer
authors: Z
authors: Keser
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Matthew
authors: M
authors: Davis
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Argyrios
authors: A
authors: Stampas
authors: Department of Mechanical Engineering, Rice University, Houston, TX, USA.
authors: Marcia K
authors: MK
authors: O'Malley
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Catherine
authors: C
authors: Cooper-Hay
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Joel
authors: J
authors: Frontera
authors: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Felipe
authors: F
authors: Fregni
authors: Department of Physical Medicine and Rehabilitation and The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Neurorecovery Research Center, University of Texas Health Science Center at Houston, TX, USA.
authors: Gerard E
authors: GE
authors: Francisco
mesh_terms: D000328:Adult; D001132:Arm / Q000503:physiopathology*; D066193:Cervical Cord / Q000293:injuries*; D004311:Double-Blind Method; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009044:Motor Cortex; D053580:Muscle Strength; D009129:Muscle Tonus; D020127:Recovery of Function; D012371:Robotics; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects / Q000379:methods*
keywords: Spinal cord injury; arm; motor recovery; non-invasive brain stimulation; rehabilitation-robotics