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Research Objectives
Acute intermittent hypoxia (AIH) and transcutaneous spinal cord stimulation (tSCS)
are two non-invasive neuromodulation treatments that have been shown to individually
induce spinal plasticity in persons with chronic incomplete spinal cord injury (iSCI).
However, these two interventions have never been tested in combination to see if their
combined effect is greater than each intervention alone. This proof of concept case
study investigated how AIH combined with tSCS during ambulation training may facilitate
improvements in walking function in individuals with iSCI.
Design
Single-blind, randomized, crossover trial.
Setting
Outpatient, Rehabilitation Hospital.
Participants
1 participant (male, 70 years) with chronic iSCI.
Interventions
The participant completed 3 arms, in random order:
1. AIH+tSCS
2. Sham-AIH+Sham-tSCS
3. Sham-AIH+tSCS
Each arm consisted of 5 treatment sessions on consecutive days.
Main Outcome Measures
Assessments were performed at Baseline, Post-intervention (Post), and 1-week follow-up
(1WFU), with a 4-week wash out between arms.
Changes in gait performance were measured using the 10-meter walk test (10MWT) for
fast and comfortable speeds, and the 6-minute walk test (6MWT).
Results
Overall, the participant showed potential improvements in his walking performance
with AIH+tSCS at Post, relative to Baseline (10MWT-Fast: 5.6%; 10MWT-Comfortable:
7.0%; 6MWT: 15.6%), with further improvements at 1WFU (10MWT-Fast: 6.9%; 10MWT-Comfortable:
19.2%; 6MWT: 19.3%). The participant also showed potential improvements at Post, relative
to Baseline with Sham-AIH+Sham-tSCS (10MWT-Fast: 12.2%; 10MWT-Comfortable: 6.6%; 6MWT:
15.1%) and with Sham-AIH+tSCS (10MWT-Fast: -2.5%; 10MWT-Comfortable: 15.3%; 6MWT:
6.0%). However, sustained improvements were not present at 1WFU with the Sham-AIH+Sham-tSCS
(10MWT-Fast: 3.8%; 10MWT-Comfortable: -2.5%; 6MWT: 8.3%) or Sham-AIH+tSCS (10MWT-Fast:
-3.9%; 10MWT-Comfortable: -5.5%; 6MWT: -2.1%), suggesting the combined intervention
yielded retention effects.
Conclusions
AIH +tSCS with gait training may promote persistent improvements in walking function
compared to tSCS with gait training or gait training alone in persons with iSCI. Further
studies are warranted to investigate this novel, combinational neuromodulation strategy.
Author(s) Disclosures
The authors have no conflicts of interest to disclose.
Keywords
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Copyright
© 2022 Published by Elsevier Inc.
