Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study
IntroductionPaired associative stimulation (PAS) consists of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of the peripheral nerve (high-PAS) and can induce plastic changes in spared corticospinal connections in individuals with spinal cord injury (SCI), le...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-02-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1486591/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832542386087002112 |
|---|---|
| author | Kirsi Holopainen Aleksandra Tolmacheva Ines Bersch Piia Haakana Piia Haakana Markus Pohjonen Erika Kirveskari Erika Kirveskari Jari Arokoski Anastasia Shulga Anastasia Shulga |
| author_facet | Kirsi Holopainen Aleksandra Tolmacheva Ines Bersch Piia Haakana Piia Haakana Markus Pohjonen Erika Kirveskari Erika Kirveskari Jari Arokoski Anastasia Shulga Anastasia Shulga |
| author_sort | Kirsi Holopainen |
| collection | DOAJ |
| description | IntroductionPaired associative stimulation (PAS) consists of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of the peripheral nerve (high-PAS) and can induce plastic changes in spared corticospinal connections in individuals with spinal cord injury (SCI), leading to the restoration of motor function. The objective of this study was to investigate the long-term effect of high-PAS on hand function and muscle strength.Materials and methodsHigh-PAS was applied to four patients with chronic, incomplete, cervical-level SCI multiple times a week for as long as hand muscle strength improved. The median, ulnar, and radial nerves of one hand chosen by the patient were stimulated. Patients underwent Medical Research Council (MRC) manual muscle testing monthly during the stimulation period and were followed for 12 months after the stimulation.ResultsStrength increased in both the stimulated and non-stimulated hands. In muscles innervated by stimulated nerves, strength increased on average by 24.5% from pre- to post-conditions (p = 0.013). The achieved strength level was maintained for a minimum of 6 months after completing the stimulations. Patients were also evaluated with motor point (MP) integrity testing to estimate the extent of lower motor neuron damage. High MP integrity testing scores (low extent of damage) correlated positively with good MRC outcomes of the stimulated hand after high-PAS (r = 0.52, p ≤ 0.001).ConclusionHigh-PAS may improve muscle strength of both the stimulated and contralateral sides. Stable results were achieved when stimulation was delivered as long as MRC score improved progressively. The optimal duration of high-PAS treatment remains unknown.Clinical trial registrationclinicaltrials.gov, identifier NCT03045744. |
| format | Article |
| id | doaj-art-88e91f9c9d1140b6b3a44425300d0bb2 |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-88e91f9c9d1140b6b3a44425300d0bb22025-02-04T05:28:06ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-02-011610.3389/fneur.2025.14865911486591Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series studyKirsi Holopainen0Aleksandra Tolmacheva1Ines Bersch2Piia Haakana3Piia Haakana4Markus Pohjonen5Erika Kirveskari6Erika Kirveskari7Jari Arokoski8Anastasia Shulga9Anastasia Shulga10BioMag Laboratory, HUS Diagnostic Centre, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, FinlandBioMag Laboratory, HUS Diagnostic Centre, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, FinlandInternational FES Centre®, Swiss Paraplegic Centre, Nottwil, SwitzerlandBioMag Laboratory, HUS Diagnostic Centre, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, FinlandDepartment of Physiology, University of Helsinki, Helsinki, FinlandDepartment of Internal Medicine and Rehabilitation, Division of Rehabilitation, Helsinki University Hospital and Helsinki University, Helsinki, FinlandBioMag Laboratory, HUS Diagnostic Centre, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, FinlandHUS Medical Imaging Centre, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, FinlandDepartment of Internal Medicine and Rehabilitation, Division of Rehabilitation, Helsinki University Hospital and Helsinki University, Helsinki, FinlandBioMag Laboratory, HUS Diagnostic Centre, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, FinlandDepartment of Internal Medicine and Rehabilitation, Division of Rehabilitation, Helsinki University Hospital and Helsinki University, Helsinki, FinlandIntroductionPaired associative stimulation (PAS) consists of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of the peripheral nerve (high-PAS) and can induce plastic changes in spared corticospinal connections in individuals with spinal cord injury (SCI), leading to the restoration of motor function. The objective of this study was to investigate the long-term effect of high-PAS on hand function and muscle strength.Materials and methodsHigh-PAS was applied to four patients with chronic, incomplete, cervical-level SCI multiple times a week for as long as hand muscle strength improved. The median, ulnar, and radial nerves of one hand chosen by the patient were stimulated. Patients underwent Medical Research Council (MRC) manual muscle testing monthly during the stimulation period and were followed for 12 months after the stimulation.ResultsStrength increased in both the stimulated and non-stimulated hands. In muscles innervated by stimulated nerves, strength increased on average by 24.5% from pre- to post-conditions (p = 0.013). The achieved strength level was maintained for a minimum of 6 months after completing the stimulations. Patients were also evaluated with motor point (MP) integrity testing to estimate the extent of lower motor neuron damage. High MP integrity testing scores (low extent of damage) correlated positively with good MRC outcomes of the stimulated hand after high-PAS (r = 0.52, p ≤ 0.001).ConclusionHigh-PAS may improve muscle strength of both the stimulated and contralateral sides. Stable results were achieved when stimulation was delivered as long as MRC score improved progressively. The optimal duration of high-PAS treatment remains unknown.Clinical trial registrationclinicaltrials.gov, identifier NCT03045744.https://www.frontiersin.org/articles/10.3389/fneur.2025.1486591/fullpaired associative stimulationtranscranial magnetic stimulationelectrical stimulationmotor point integrity testingspinal cord injury |
| spellingShingle | Kirsi Holopainen Aleksandra Tolmacheva Ines Bersch Piia Haakana Piia Haakana Markus Pohjonen Erika Kirveskari Erika Kirveskari Jari Arokoski Anastasia Shulga Anastasia Shulga Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study Frontiers in Neurology paired associative stimulation transcranial magnetic stimulation electrical stimulation motor point integrity testing spinal cord injury |
| title | Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study |
| title_full | Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study |
| title_fullStr | Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study |
| title_full_unstemmed | Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study |
| title_short | Stable improvement in hand muscle strength in incomplete spinal cord injury patients by long-term paired associative stimulation—a case series study |
| title_sort | stable improvement in hand muscle strength in incomplete spinal cord injury patients by long term paired associative stimulation a case series study |
| topic | paired associative stimulation transcranial magnetic stimulation electrical stimulation motor point integrity testing spinal cord injury |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1486591/full |
| work_keys_str_mv | AT kirsiholopainen stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT aleksandratolmacheva stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT inesbersch stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT piiahaakana stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT piiahaakana stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT markuspohjonen stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT erikakirveskari stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT erikakirveskari stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT jariarokoski stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT anastasiashulga stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy AT anastasiashulga stableimprovementinhandmusclestrengthinincompletespinalcordinjurypatientsbylongtermpairedassociativestimulationacaseseriesstudy |