The effects of epidural stimulation on individuals living with spinal cord injury or disease: a scoping review

Abstract

Background

Spinal cord injury/disease (SCI/D) impacts sensory, motor and autonomic function. Epidural stimulation (ES) has the potential to improve function across many domains.

Objective

To synthesize the effects of ES on functional goals for individuals with SCI/D.

Methods

Seven biomedical databases were searched. Inclusion criteria required (1) ES as the primary intervention, (2) human participants with SCI/D, (3) pre-post measure of an orthotic and/or therapeutic effect, and (4) original data. Data extracted were participant characteristics, ES and exercise parameters, outcome measures, complications, orthotic and/or therapeutic effects. Data were synthesized descriptively according to functional goal. Critical appraisal was completed using the Downs and Black modified checklist.

Results

Included studies were case studies or case-series (n = 24), or pre-post interventions (n = 23). One study was a case-control. Research quality was poor to fair. There were mixed results of ES on bladder and sexual function, and standing in participants with SCI/D. Effects of ES included improved bowel function, increased cardiorespiratory and cardiometabolic function, pain reduction, decreased spasms and spasticity, and, when combined with repetitive movement training, improved gait parameters. In the one study focused on the upper extremity, grip strength improved.

Conclusions

ES shows promise as an intervention to improve functional goals after SCI/D with a focus on locomotion.

Keywords:

• Spinal cord injury
• epidural stimulation
• motor function
• pain
• urinary bladder

Acknowledgements

Special thanks to Katherine Chan, MSc, for administrative assistance.

Disclosure statement

The authors have no conflicts to declare.

Additional information

Funding

This work was supported by the Ontario Government Early Researcher Award awarded to Dr. Kristin E. Musselman.

Notes on contributors

Hope Jervis Rademeyer

Hope Jervis Rademeyer is a physical therapist and PhD candidate in Rehabilitation Science at the University of Toronto. She completed a BA in Psychology in 2015, and a Masters of Physical Therapy at the University of Saskatchewan in 2017. She also holds a BA in Kinesiology and Physical Education from Wilfrid Laurier University. Her PhD thesis project, under the supervision of Dr. Kristin Musselman, investigates the use of technology to augment traditional rehabilitation for people with spinal cord injury or disease.

Cindy Gauthier

Cindy Gauthier is a physical therapist who graduated from the Université de Montréal in 2013. She did her PhD degree under the supervision of Dr. Dany Gagnon from the Université de Montréal and Dr. Audrey L. Hicks from McMaster University. In 2018, she obtained her PhD from the School of Rehabilitation of the Université de Montréal. In 2019, she joined the SCI-Mobility Lab for a postdoctoral fellowship with Dr. Kristin Musselman after being awarded with The Rick and Amanda Hansen Fellowship, in partnership with Praxis Spinal Cord Institute and Ontario Neurotrauma Foundation. During her fellowship, she studied the effects of electrical stimulation during functional activity and activity-based therapy training among individuals with spinal cord injury. She is also part of the Canadian ABT Community of Practice.

Kei Masani

Kei Masani is a Scientist with the Neural Engineering and Therapeutics Team at the KITE Research Institute and an Assistant Professor (status) in the Institute of Biomedical Engineering, University of Toronto. His research interests include understanding human movement and movement variability, from the view of neuro-mechanical interaction and sensory-motor integration. Particularly, he focuses on developing accurate assessments and therapeutic tools using functional electrical stimulation for standing, walking and adapted exercise. He received a B.Sc. and a M.Sc. in Physical Education from the University of Tokyo, and a Ph.D. in Physical and Health Education from the University of Tokyo. He has published over 120 articles on related topics.

Maureen Pakosh

Maureen Pakosh graduated from the University of Toronto with a Masters of Information Studies degree. She has worked in the medical library field for 25 years, the last 10 years as an Information Specialist at the ‘north site’ facility of the University Health Network, Toronto Rehabilitation Institute in Toronto, Canada. A key aspect of Maureen’s work is participating on systematic review teams with researchers in the Neuro, Spinal Cord, and Cardiac/Cardiovascular areas of rehabilitation. In addition, Maureen supports and provides information and instruction to the clinical and administrative staff within the Lyndhurst, Rumsey Neuro, and Rumsey Cardiac Centres. One of Maureen’s special library projects has been utilizing her rehab knowledge and experience to develop a Rehabilitation Resources libguide (https://guides.hsict.library.utoronto.ca/uhnrehab) that is accessible to all rehab involved personnel—both within and outside of UHN.

Kristin E. Musselman

Kristin E. Musselman is a physical therapist, Assistant Professor in the Department of Physical Therapy at the University of Toronto, and a Scientist at KITE-Toronto Rehabilitation Institute. She completed BSc degrees in Life Sciences and Physical Therapy at Queen’s University in Kingston, ON, and an MSc in Neuroscience and PhD in Rehabilitation Science at the University of Alberta. Dr. Musselman was a Post-doctoral Fellow at the Johns Hopkins School of Medicine and Kennedy Krieger Institute from 2010–2013. The overarching aim of Dr. Musselman’s research is to develop innovative, clinically feasible approaches to restore movement, function and participation for individuals living with complex neurological disease across the lifespan.