Paired associative stimulation improves hand function after nontraumatic spinal cord injury: a case series

Aleksandra Tolmacheva, Sarianna Savolainen, Erika Kirveskari, Nina Brandstack, Jyrki Mäkelä, Anastasia Shulga

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

Sammanfattning

Objectives Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with nontraumatic neurological SCI. Methods In this case series five patients with nontraumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated with manual muscle testing (MMT) before and immediately after therapy and at the 1- and 6-month follow ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch, and Box and Blocks tests. Results All patients had improved MMT values at all post-PAS evaluations. The mean±standard error MMT increase was 1.44±0.37 points (p=0.043) immediately after PAS, 1.57±0.4 points (p=0.043) at the 1-month follow-up, and 1.71±0.47 points (p=0.043) at the 6-month follow up. The pinch, digital dynamometry values, and Box and Blocks test results also improved in all patients. Conclusions Long-term PAS may be a safe and effective treatment for improving hand function in patients with nontraumatic tetraplegia. Significance This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.
Originalspråkengelska
TidskriftClinical neurophysiology practice
ISSN2467-981X
DOI
StatusPublicerad - 13 aug 2019
MoE-publikationstypA1 Tidskriftsartikel-refererad

Vetenskapsgrenar

  • 3112 Neurovetenskaper

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title = "Paired associative stimulation improves hand function after nontraumatic spinal cord injury: a case series",
abstract = "Objectives Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with nontraumatic neurological SCI. Methods In this case series five patients with nontraumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated with manual muscle testing (MMT) before and immediately after therapy and at the 1- and 6-month follow ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch, and Box and Blocks tests. Results All patients had improved MMT values at all post-PAS evaluations. The mean±standard error MMT increase was 1.44±0.37 points (p=0.043) immediately after PAS, 1.57±0.4 points (p=0.043) at the 1-month follow-up, and 1.71±0.47 points (p=0.043) at the 6-month follow up. The pinch, digital dynamometry values, and Box and Blocks test results also improved in all patients. Conclusions Long-term PAS may be a safe and effective treatment for improving hand function in patients with nontraumatic tetraplegia. Significance This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.",
keywords = "TMS, Rehabilitation, Plasticity, Spinal Cord, Paired Associative Stimulation, Spinal Cord Injury, 3112 Neurosciences",
author = "Aleksandra Tolmacheva and Sarianna Savolainen and Erika Kirveskari and Nina Brandstack and Jyrki M{\"a}kel{\"a} and Anastasia Shulga",
year = "2019",
month = "8",
day = "13",
doi = "10.1016/j.cnp.2019.07.002",
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Paired associative stimulation improves hand function after nontraumatic spinal cord injury: a case series. / Tolmacheva, Aleksandra; Savolainen, Sarianna; Kirveskari, Erika; Brandstack, Nina; Mäkelä, Jyrki; Shulga, Anastasia.

I: Clinical neurophysiology practice, 13.08.2019.

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

TY - JOUR

T1 - Paired associative stimulation improves hand function after nontraumatic spinal cord injury: a case series

AU - Tolmacheva, Aleksandra

AU - Savolainen, Sarianna

AU - Kirveskari, Erika

AU - Brandstack, Nina

AU - Mäkelä, Jyrki

AU - Shulga, Anastasia

PY - 2019/8/13

Y1 - 2019/8/13

N2 - Objectives Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with nontraumatic neurological SCI. Methods In this case series five patients with nontraumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated with manual muscle testing (MMT) before and immediately after therapy and at the 1- and 6-month follow ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch, and Box and Blocks tests. Results All patients had improved MMT values at all post-PAS evaluations. The mean±standard error MMT increase was 1.44±0.37 points (p=0.043) immediately after PAS, 1.57±0.4 points (p=0.043) at the 1-month follow-up, and 1.71±0.47 points (p=0.043) at the 6-month follow up. The pinch, digital dynamometry values, and Box and Blocks test results also improved in all patients. Conclusions Long-term PAS may be a safe and effective treatment for improving hand function in patients with nontraumatic tetraplegia. Significance This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.

AB - Objectives Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with nontraumatic neurological SCI. Methods In this case series five patients with nontraumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated with manual muscle testing (MMT) before and immediately after therapy and at the 1- and 6-month follow ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch, and Box and Blocks tests. Results All patients had improved MMT values at all post-PAS evaluations. The mean±standard error MMT increase was 1.44±0.37 points (p=0.043) immediately after PAS, 1.57±0.4 points (p=0.043) at the 1-month follow-up, and 1.71±0.47 points (p=0.043) at the 6-month follow up. The pinch, digital dynamometry values, and Box and Blocks test results also improved in all patients. Conclusions Long-term PAS may be a safe and effective treatment for improving hand function in patients with nontraumatic tetraplegia. Significance This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.

KW - TMS

KW - Rehabilitation

KW - Plasticity

KW - Spinal Cord

KW - Paired Associative Stimulation

KW - Spinal Cord Injury

KW - 3112 Neurosciences

U2 - 10.1016/j.cnp.2019.07.002

DO - 10.1016/j.cnp.2019.07.002

M3 - Article

JO - Clinical neurophysiology practice

JF - Clinical neurophysiology practice

SN - 2467-981X

ER -