Resumen de Development of a neuromodulation-based therapy for the rehabilitation of patiens with SCI
Spinal cord injury (SCI) refers to a damage to the spinal cord that affects sensory, motor, or autonomic functions, with a huge impact on the patient and on the society. Locomotion is one of the more frequently affected functions after SCI, and therefore his recovery is a high priority for these subjects.
Upstanding locomotor training exercises are commonly performed to rehabilitate locomotion: this effect is attributed to the repetitive stimulation of specific motor pathways in combination with the reception of an appropriate sensory feedback, which helps to restore proper sensorimotor integration - the coupling between the sensory and motor systems. Unfortunately, these therapies are tiring for the patient and demanding for the therapists. Furthermore, they cannot be performed in the first period after the injury, a period of fundamental importance for maximising rehabilitation outcomes.
On the contrary, leg-cycling is a commonly recommended exercise that activates similar control networks as locomotion and suitable to be performed early after the lesion or by the most impaired subjects. However, during leg-cycling, the afferent feedback produced by load receptors and plantar cutaneous mechanoreceptors is limited.
In this thesis, we consider the opportunity to combine leg-cycling with the delivery of plantar electrical stimulation that would increase sensory system recruitment. To this account, we compared the effects of single-bout sessions of cycling and cycling with electrical stimulation, applied to non-injured subjects and subjects with iSCI. To estimate the early effects of the therapy, we developed a test of spinal sensorimotor integration, based on the assessment of soleus H-reflex excitability following a conditioning electrical stimulation delivered to the ipsilateral plantar surface of the subject. Lastly, we propose a procedure, based on this assessment technique and on the leg cycling exercise, to perform a deeper examination of spinal sensorimotor integration in subjects with SCI.
