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Radha Korupolu, MBBS, MS (pgy2) Physical Medicine & Rehabilitation University of Kentucky

Spinal transcutaneous direct current stimulation to enhance locomotor training after spinal cord injury. Radha Korupolu, MBBS, MS (pgy2) Physical Medicine & Rehabilitation University of Kentucky. Mentor : Lumy Sawaki , MD, PhD Collaborator : Kenneth Chelette , MS

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Radha Korupolu, MBBS, MS (pgy2) Physical Medicine & Rehabilitation University of Kentucky

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  1. Spinal transcutaneous direct current stimulation to enhance locomotor training after spinal cord injury Radha Korupolu, MBBS, MS (pgy2) Physical Medicine & Rehabilitation University of Kentucky • Mentor: LumySawaki, MD, PhD • Collaborator: Kenneth Chelette, MS • University of Kentucky & Cardinal Hill Rehabilitation Hospital

  2. Background • Transcranial direct current stimulation • Modulates cortical excitability • Anodal stimulation increases neuronal firing rate • Cathode stimulation decreases neuronal firing rate • Effects may last for >1 hr after stimulation • Inexpensive • Non-invasive Nitsche et al., 2008; Nitsche et al., 2003; Priori, 2003

  3. Transcranialdirect current stimulation (tDCS) • Possible Mechanism: • Changes the resting membrane potential of the neurons in cortex • Adjuvant treatment options for pts suffering from • Stroke • Chronic pain • Depression • Cognitive deficits Hummel et al., 2005;Fregni et al., 2006a,b

  4. Transcutaneous spinal direct current stimulation (tsDCS) Preliminary studies in healthy subjects Suggest possibility of similar modulation in spinal neurons

  5. F. Cogiamanian et al. (2008) • Sample size : • 12 healthy subjects • Intervention: • tsDCS over T10 spinous process • 2.5 mA for 15 mins • anodal or cathodal • Outcome Measures: • Post. TibialN & Median N SEPs were recorded • Before, at current offset & 20 min after tcDCS (anodal/ cathodalDC)

  6. F. Cogiamanian et al. (2008) • Results • Anodal tcDCS decreased PTN SEPs amp by 25% • Effect lasted atleast 20 min • Serum neuronespecific enolase (NSE), a marker of neuronal damage • NSE level before & 1 h after stimulation measured in 5 subjects was not elevated after tsDCS

  7. T. Winkler et al. (2010) • Sample size : • 10 healthy subjects • Intervention: • tcDCS at T11 level 2 cm paravertebrally • 2.5 mA applied for 15 min • Cathodal, anodal or sham • Each subject received all modes of stim 1 week apart

  8. T. Winkler et al. (2010) • Outcome measures: • H-reflex • Before, at current offset, & 15 min after anodal, cathodal or sham tsDCS. • Results • Anodal tsDCS: • Down-regulated spinal excitability • Cathodal tsDCS: • Up-regulated spinal excitability

  9. Our research plan • Aim to study effects of tsDCS in 3 phases • Proposed objectives for the first phase: • Establish a reliable &reproducible spinal tsDCS methodology to modulate spinal excitability in healthy subjects

  10. Proposed methods for first phase • Sample size: 10 healthy subjects • Intervention: • Anodal, cathodal or sham tsDCS at T11 2 cm paraspinally • 2mA for 15 mins • Outcome measures: • MEPs will be evoked using trans magnetic stimulation • MEPs, H-reflex and F-wave will be recorded via surface electrodes over gastrocnemius muscle & abductor hallucis muscle bilaterally before & after tsDCS

  11. Reference electrode at infraclavicular area Active electrode T11 2 cm from spinous process Direct current stimulator

  12. Transcranial Magnetic Stimulation MEP amplitude

  13. First phase Anticipated Results • Improved motor output following cathodaltsDCS • Increased MEPs • Increased F wave and • Decreased H reflex

  14. Preliminary results: • Preliminary testing in a single healthy subject suggests that cathodal tsDCS at T11 has greater facilitatory effects on MEPs compared to anodal tsDCS

  15. Scientific plan • Secondphase: • Apply the tsDCS methodology developed in phase one to subjects with SCI • Evaluate modulation of spinal excitability • Same outcome measures as in 1stphase • If measures show favorable findings then we will progress to phase three

  16. Scientific plan • Third Phase: Our long term objective is to evaluate the effects of tsDCS on functional motor recovery, paired with robot-assisted treadmill training in subjects with SCI

  17. Potential Problems • Skin irritation & lesions have been reported following transcutaneous DC stimulation (caution in SCI) • Pain • Duration of the effects • Is there any potential for inducing autonomic dysreflexia?

  18. Discussion • If successful the proposed stimulation technique would mark a significant advancement in the field of SCI rehabilitation • Non-invasive • Inexpensive

  19. Questions

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