Restoration of arm and hand functions via noninvasive cervical cord neuromodulation after traumatic brain injury: a case study

ABSTRACT

Objectives: To investigate the effects of transcutaneous electrical stimulation (tES) on upper limb functional rehabilitation in a patient with traumatic brain injury (TBI), and to identify the optimum stimulation parameters of tES.

Design: A preliminary case study.

Methods: Two successive interventions: Phase I–voluntary physical training (vPT) and Phase II – tES along with vPT (tES+vPT). tES was delivered at C3 and C6 cervical regions. Clinical assessments presented the variation of muscle tone and motor functions, before and after each training phase, and evaluated at 1-month follow up after the last intervention.

Results: Our results indicate that vPT alone contributed to a release of muscle spasticity of both arms of the patient with no significant improvement of hand function, while tES+vPT further reduced the spasticity of the left arm, and improved the voluntary motor function of both arms. The grip forces were also increased after the tES+vPT treatment. We found that 1 ms biphasic tES at 30 Hz produced optimum motor outputs.

Conclusion: The study demonstrates, for the first time, the potential benefits of cervical tES in regard to improving upper limb motor functions in a patient with chronic TBI.

KEYWORDS:

• Traumatic brain injury
• bilateral upper extremity motor deficits
• transcutaneous electrical stimulation
• neuromodulation
• functional rehabilitation

Acknowledgments

We wish to thank the study participant for his enthusiasm and hard work in the training sessions. We also wish to thank Lee Ning Wong for arranging all the training sessions, Chin Yi Nam for helping with the clinical evaluations, and our students, Jie Song and Hong Wing Leung for helping us to train the participant.

Declaration of interest statement

The authors declare no conflict of interests.

Additional information

Funding

This research study was partially supported by the Hong Kong Polytechnic University (H-ZG4W), Guangdong Provincial Work Injury Rehabilitation Center (H-ZG4W), Hong Kong Innovation and Technology Fund (ITS/276/17), Tai Hung Fai Charitable Foundation (847L), and Telefield Charitable Fund (83D1).