Priming With Transcutaneous Spinal Direct Current Stimulation Followed by Robotic Exoskeleton Gait Training in Individuals With Spinal Cord Injury: A Case Series

Authors

• Marcie Kern
• Catherine Velasquez-Ignacio
• Taimoor Afzal
• Shih-Chiao Tseng
• Gerard E Francisco
• Shuo-Hsiu Chang

Language

English

Publication Date

11-1-2025

Journal

The Journal of Spinal Cord Medicine

DOI

10.1080/10790268.2025.2479955

PMID

40163080

PMCID

PMC12628658

PubMedCentral® Posted Date

3-31-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Objectives: To investigate the safety and feasibility of repeated transcutaneous spinal direct current stimulation (tsDCS) as priming strategy during exoskeleton-assisted locomotor training in individuals with SCI and evaluate potential neurophysiologic and functional gait changes.

Study design: Case series experimental design.

Setting: Research laboratory at a post-acute rehabilitation hospital.

Participants: Four participants with chronic incomplete SCI.

Interventions: Four participants with chronic incomplete SCI received three weeks of training consisting of two types of interventions after baseline (A): 20-minute tsDCS (anode or cathode) applied over the spinous processes of T10 followed by 20-minute exoskeleton-assisted locomotor training (B, B1, B2) and 20-minute exoskeleton-assisted locomotor training (C, C1, C2). Each phase consisted of five consecutive intervention sessions. Two participants underwent sequence A-B1-C-B2 and two sequence A-C1-B-C2. Soleus Hoffmann Reflex (H-reflex) and gait speed (10-m walk test) were assessed on the first and fifth days of training for each training type.

Outcome measures: Adverse skin reactions or other events, H-reflex (Hmax/Mmax ratio), and gait speed (10-m walk test).

Results: No adverse events occurred. All participants tolerated tsDCS with no negative effects on their skin. Participants demonstrated varied responses in their H/M ratios after tsDCS followed by exoskeleton-assisted locomotor training as well as after exoskeleton-assisted locomotor training. No consistent pattern can be identified in this case series. Three participants showed an increase in gait speed after tsDCS combined with exoskeleton-assisted locomotor training.

Conclusions: Noninvasive repeated spinal stimulation can safely be used in individuals with incomplete SCI. Further large-scale research is necessary to determine the efficacy of tsDCS for priming the spinal cord in facilitating recovery of gait in individuals with SCI.

Keywords

Humans, Spinal Cord Injuries, Exoskeleton Device, Male, Adult, Female, Middle Aged, Transcutaneous Electric Nerve Stimulation, Exercise Therapy, Gait, Robotics, Gait Disorders, Neurologic, H-Reflex, Neuromodulation, Transcutaneous spinal direct current stimulation, Wearable exoskeleton, Spinal cord injury

Published Open-Access

yes

Recommended Citation

Kern, Marcie; Velasquez-Ignacio, Catherine; Afzal, Taimoor; et al., "Priming With Transcutaneous Spinal Direct Current Stimulation Followed by Robotic Exoskeleton Gait Training in Individuals With Spinal Cord Injury: A Case Series" (2025). Faculty, Staff and Student Publications. 4302.
https://digitalcommons.library.tmc.edu/uthmed_docs/4302