Training of isometric force tracking to improve motor control of the wrist after incomplete spinal cord injury: A case report

Physiother Theory Pract., 2023 · DOI: 10.1080/09593985.2022.2049405 · Published: August 3, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This case report focuses on improving upper limb function, specifically wrist motor control, for individuals with cervical spinal cord injury (SCI). It describes a technology-based approach to activate spared neural pathways. The participant, a 73-year-old man with incomplete C5 SCI, underwent 24 training sessions involving isometric wrist flexor and extensor contractions to match a visual target force curve. The study tracked error rates, muscle activation (using EMG), and corticospinal excitability (using TMS) to understand how motor skill training could improve motor control after SCI.

Study Duration

92 days

Participants

A 73-year-old man with chronic incomplete C5 SCI

Evidence Level

Level 4, Case Report

Key Findings

1
Error in force tracking improved with training, with similar gains during both extension and flexion phases.
2
Improvements were associated with greater flexor muscle activation during flexion phases and greater extensor muscle relaxation during flexion phases.
3
Small improvements were observed in active range of motion, grip force, spasticity, touch sensation, and corticospinal excitability.

Research Summary

This case report explores using technology-based motor skill training to improve wrist motor control in a man with incomplete SCI. The training involved isometric force tracking, and the participant showed improved motor control with associated changes in muscle activation patterns and increased corticospinal excitability. The study highlights the potential for personalized rehabilitation approaches that target specific muscle activation adjustments to enhance motor control after SCI.

Practical Implications

Personalized Rehabilitation

Findings suggest the need for personalized rehabilitation strategies based on individual impairment patterns to maximize motor control recovery.

Targeted Muscle Training

Targeted training of specific muscle groups (e.g., wrist flexors and extensors) can improve precise motor control, even years after SCI.

Neurofeedback Strategies

Neurofeedback strategies may be beneficial to increase awareness of antagonist muscle activation and improve motor control.

Study Limitations

1
Single case study limits generalizability.
2
Modest gains on activity level tests suggest focused intervention may not translate to broad functional improvements.
3
Fatigue and discomfort limited the extent of TMS testing.

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