Julio Furlan, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada

Defining the mechanisms of action of FES therapy applied along with gait retraining for rehabilitation of paraplegics

Funded in: 2016, 2017, 2018

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Problem: Define the appropriate and timely treatment to improve walking function in SCI patients

Target: Neuroplastic changes associated with FES-t applied in combination with task-specific gait training

Goal: Improvements in walking ability and reduce disability of SCI patients.

Restoration of the walking function is highly valued by individuals with SCI. Many individuals with paraplegia have the potential to recover walking function if appropriate and timely treatment of appropriate intensity is applied. In our institution, clinical trials focused on multichannel Functional Electrical Stimulation therapy (FES-t) in combination with task-specific motor training in tetraplegics have revealed improvements of hand function. FES-t uses short electrical pulses to generate muscle contraction. There is a growing body of evidence to support the effectiveness of FES-t, even though its exact mechanism of action remains largely unknown.

We hypothesize that FES-t in combination with over ground locomotion using an over-head track with body harness will promote functional changes (i.e. electrophysiological parameters and functional MRI features) reflecting alterations in the nervous system pathways, which will parallel the observed improvements in walking ability and reduce disability of individuals with SCI.

This research project will include:

(1) Systematic reviews of the literature focused on: (i) the electrophysiological changes in the nervous system pathways after SCI; and (ii) the neuroplastic changes (“reorganization”) of the nervous system attributed to FES-t when used for gait rehabilitation after SCI.

(2) A prospective study focused on the potential electrophysiological responses to, and brain neuroplastic changes associated with FES-t applied in combination with task-specific gait training for early rehabilitation of 10 individuals with traumatic, subacute (1 to 6 months post-injury), motor incomplete, thoracic SCI. All patients will receive 40 sessions of multichannel FES-t in combination with over ground gait training. Pre- and post-treatment assessments will include clinical outcome measures, electrophysiological evaluations and functional MRI analyses.

We anticipate that this research proposal will address important aspects of SCI in terms of neuroplasticity induced by FES-t in combination with gait retraining, development of a protocol for neurophysiological assessment of patients with paraplegia, and acquisition of key data pilot data to be used in future clinical trials using FES-t in the motor rehabilitation.