Blog: Jolting the brain for recovery


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Almost half of the spinal cord injured patients suffer from tetraplegia. The injury results in partial or total loss of use of all four limbs and torso. In particular, the loss of arm and hand function affects meaningful and independent engagement in multiple life domains as it affects many types of all-day life activities. Even currently there is no effective treatment available, any improvement, even minimal in their function could make a huge difference for their quality of life.

Dr Lumy Sawaki is testing a method to exactly achieve this. She works in the department of Physical Medicine and Rehabilitation of the University of Kentucky in Lexington (USA). Currently her team demonstrated that a non-invasive brain stimulation, coupled with motor training, can improve functions in few chronic spinal cord injured patients. However, still very little is known about how such a treatment impacts the brain and the spine. And it is not clear if quality of life can be improved. That is the reason why Sawaki decided to start the so called IGNITE trial.

Transcranial direct current stimulation
There are several methods to stimulate brain activity with electricity. Sawaki and her team chose transcranial direct current stimulation, simply called tDCS, for this study. The principle is simple: tDCS works by applying a positive or negative low current delivered via electrodes on the surface of the head, making it a non-invasive technique.

The current flows inside the brain, but its intensity is in fact so low that it cannot initiate neurons to fire a message. It somehow supercharges the brain and increases cortical excitability.

Scientists believe that this fosters the ability of neurons to respond to a signal. For example, the subject does a physical training while the brain is stimulated. The training produces learning, while the tDCS amplifies it. This is a typical example of what scientists call neuromodulation. One of the advantages of this technique is its safety without any unwanted side-effect.

The IGNITE trial
The scientists plan on thoroughly testing the method on a large group of persons. 36 participants will be recruited with a chronic incomplete cervical spinal cord injury, classified B, C or D by the American Spinal Injury Association Impairment Scale.

Participants will begin 24 days of stimulations combined with task-oriented training and will be thoroughly evaluated until four months after the last stimulation. Evaluations will clinically monitor improvements in hand or arm movements, measure overall quality of life via interviews and even try to measure functional changes in the brain, via another electrophysiological testing (transcranial magnetic stimulation).

They will run a state-of-the-art clinical trial by having half of the participants receive an inactive brain stimulation while still doing the same physical training. We can then be sure that any effect, as small as it is, will come from the electrical brain stimulation.

Conclusion
Achieving their goals will be fundamental to advance interventions to promote improvement of arm and hand function after a spinal cord injury. The trial should be completed in the next three years. Its success could provide a fantastic new rehabilitation method for chronic incomplete cervical spinal cord injuries. This could help patients to harness all the recovery potential that their body has.
It’s also important to keep in mind that the technique should probably work for other types of injuries, but further studies are needed to demonstrate it.

Vieri Failli is a doctor of neuroscience, but has a passion for bringing the general public closer to the most complex questions of science.
Vieri Failli is a doctor of neuroscience, but has a passion for bringing the general public closer to the most complex questions of science.