Finding the Best Combination of Brain and Spinal Cord Stimulation With Hand Training After Spinal Cord Injury

Amplitude of motor evoked potential at the first dorsal interosseous muscle.

While physical exercise remains the foundation for any rehabilitation therapy, the team seeks
 to improve the benefits of exercise by combining it with the concept of Fire Together, Wire
 Together - when brain stimulation is synchronized with spinal cord stimulation, nerve
 circuits in the spinal cord strengthen - a phenomenon termed Spinal Cord Associative
 Plasticity, or SCAP.
 
 This project will build on the team's promising preliminary findings. When one pulse of brain
 stimulation is synchronized with one pulse of cervical spinal stimulation, hand muscle
 responses are larger than with brain stimulation alone or unsynchronized stimulation.
 However, the team does not know the best ways to apply SCAP repetitively, especially in
 conjunction with exercise, to increase and extend improvements in clinical function. Do ideal
 intervention parameters vary across individuals, or do they need to be customized?
 
 The team will take a systematic approach with people who have chronic cervical SCI to
 determine each person's best combination of SCAP with task-oriented hand exercise.
 Participants will undergo roughly 50 intervention, verification, and follow-up sessions over
 6 to 10 months each. The team will measure clinical and physiological responses of hand and
 arm muscles to each intervention.
 
 Regaining control over hand function represents the top priority for individuals with
 cervical SCI. Furthermore, this approach could be compatible with other future interventions,
 including medications and cell-based treatments.