Combined Activity-based Therapy and Transcutaneous Cervical Spinal Cord Stimulation for Upper Limb Recovery: Perspectives of People with Lived Experience of Cervical Spinal Cord Injuries

Research Objectives: This study aimed to explore the perspectives of people with lived experience of cervical spinal cord injury regarding their perceived benefits, barriers and facilitators of a combined activity-based training (ABT) and transcutaneous cervical spinal cord stimulation (TCSCS) for upper limb recovery.

Design: A qualitative study with semi-structured interviews were conducted with people who completed the combined ABT and TCSCS training. People with lived experience (PwLE) of cervical spinal cord injuries (cSCI) were interviewed individually to explore the self-perceived benefits, barriers, efficacy of delivery, extent of engagement and acceptability of the combined ABT and TCSCS training. All interviews were audio and video recorded on Microsoft TEAMS. Digital recordings were transcribed verbatim and underwent inductive thematic analysis.

Setting: Toronto Rehabilitation Institute, Lyndhurst centre, Toronto, Canada

Participants: Three males and three females with PwLE of cSCI (age range: 30.8-74.8 years) completed the study. They had incomplete injuries (ASIA impairment scale between C and D) at low and high neurological levels (between C2-C5). All participants were chronic to very chronic (range of time post-cSCI: 2.3-16.1 years).

Interventions: The ABT program included: arm cranking, strengthening, postural, and functional exercises. TCSCS was delivered between C3 and C7 vertebrae at 30-50 Hz and 500-1000 µs. 12 sessions of ABT only were delivered, followed by 28 sessions of combined ABT-TCSCS, delivered three times a week (1 hour/session).

Main Outcome Measures: Not applicable

Results: Five participants reported improved motor function such as increased strength of proximal muscles of the arms and fine motor skills of their hands. All participants reported an increase of tactile touch sensations in their hands. The frequency and duration of the combined ABT-TCSCS training was perceived as sufficient and satisfactory. All participants found the combined ABT-TCSCS training complementary to their ongoing home-based physiotherapy sessions. All participants reported that they enjoyed the interactions with the therapists and would recommend the combined ABT-TCSCS training intervention to other PwLE of cSCI. They also recommended that the combined ABT-TCSCS be delivered as part of standard care to in-patients.

Conclusions: The combined ABT-TCSCS could be a promising neurorestoration intervention to improve limb recovery after cSCI.

Author(s) Disclosures: Urvashy Gopaul has no financial or non-financial disclosures.
Mark Bayley is a speaker at Everpharma and received Honoraria).
Gita Gholamrezaei has no financial or non-financial disclosures.
Sukhvinder Kalsi-Ryan has Stockholder/Ownership Interest (excluding diversified mutual funds)) at Neural Outcomes Consulting Inc.