Restoration of hand function with long-term paired associative stimulation after chronic incomplete tetraplegia: a case study

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0225-5 · Published: August 19, 2019

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

This case study investigates if long-term paired associative stimulation (PAS) can improve hand function in someone with a long-term spinal cord injury. The aim was to continue PAS until the hand muscles fully recovered or until no further improvement was seen. A 46-year-old man with incomplete tetraplegia received PAS three times a week. After 24 weeks, the PAS was combined with motor training for his weak hand muscles. They measured his muscle strength, hand function, and independence levels. After 47 weeks of PAS, the man's self-care and mobility improved, and he could do more complex motor tasks. His left hand fully regained its muscle strength, and the right hand also showed significant improvement. These improvements lasted for several months, suggesting that PAS can create lasting changes in the brain and spinal cord.

Study Duration

47 weeks of PAS with a 32-week follow-up

Participants

A 46-year-old man with traumatic C7 AIS B tetraplegia

Evidence Level

Level 4; Case Study

Key Findings

1
After 47 weeks of PAS, the subject's SCIM score improved from 40 to 56, indicating improved self-care and indoor mobility.
2
The subject's left hand regained maximum MMT score (total 75; increase of score from baseline condition 19), and the effect remained stable during the 32-week follow-up.
3
In the right-hand muscles, MMT scores of 4–5 were observed in follow up (total 71; increase from baseline 48), indicating significant improvement in muscle strength.

Research Summary

This case study demonstrates that long-term paired associative stimulation (PAS) can lead to significant improvements in hand function for individuals with chronic incomplete tetraplegia. The subject experienced improved muscle strength, hand function, and independence, as measured by MMT scores and SCIM scores, respectively. The positive effects of PAS persisted for several months after the intervention, suggesting stable plastic changes in the corticospinal pathway.

Practical Implications

Clinical Application

Long-term PAS protocols could be further developed for the rehabilitation of individuals with SCI at chronic and sub-acute stages, potentially restoring hand function.

Accessibility

The TMS and PNS equipment used in this study are available in many hospitals and laboratories, making this intervention potentially accessible in clinical settings.

Personalized Rehabilitation

Focusing on the most injured connections through PAS may be clinically meaningful, especially in asymmetric incomplete SCI, allowing for targeted rehabilitation.

Study Limitations

1
This study is limited to results of one subject only.
2
A larger sample with a longer duration of the intervention would be required to demonstrate the efﬁcacy of this intervention.
3
Not specified

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