Functional Electrical Stimulations With and Without Motor Priming Exercises in Spinal Cord Injury
Condition: Spinal Cord Injury
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      As functional electrical stimulations has evident role in improving motor control in
      tenodesis function (power and precision grip) but its results are considered to be short term
      so addition of task oriented approach i.e. motor priming exercises could enhance the
      treatment effects . Priming is a mechanism that could easily be a part of a restorative
      occupational therapy approach, is a therapeutic method with the intent to improve function by
      targeting underlying neural mechanisms (neuroplasticity and motor control). This will yield
      the long term effects of priming augmented functional electrical stimulations to enhance the
      tenodesis function of patients with spinal cord injury. Their combination may produce
      improvement in hand functions dexterity in spinal cord injury patients.
    

Detailed description: 
      Spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent
      changes in or loss of muscle function, sensation, or autonomic function in the parts of the
      body served by the spinal cord, below the level of the injury. People with Spinal cord injury
      (C6-7 tetraplegia) are often lacking grip strength, causing impairment in activities of daily
      living. Variety of physiotherapy approaches such as electrical stimulations and different
      exercise regimes has been used in rehabilitation program of spinal cord injuries. Functional
      electrical impulses apply to nerves and muscles to restore muscle function in people with
      spinal cord injury. Second, priming of the motor cortex with motor priming exercises is
      associated with neuroplastic changes and improved motor performance.

      This will be a randomized control trail and the study aims to determine which group will show
      better results of functional electrical stimulations with or without motor priming exercise
      on tenodesis grip in sub acute spinal cord injury patients. Evidences support that, in more
      than 40 years of functional electrical stimulation research, principles for safe stimulation
      of neuromuscular tissue have been established; it has been developed for restoring function
      in the upper extremity, lower extremity, bladder and bowel, and respiratory system. Paralyzed
      or paretic muscles can be made to contract by applying

      electrical currents to the intact peripheral motor nerves innervating them. When electrically
      elicited muscle contractions are coordinated in a manner that provides function, the
      technique is termed functional electrical stimulation (FES)

      Another approach is Motor priming, which is receiving considerable attention as a way of
      augmenting the effects of rehabilitation-related training in neurologic clinical populations.
      Much of the early work related to motor priming to improve hand function in persons with
      tetraplegia) Priming is a non-conscious process associated with learning where exposure to a
      stimulus alters the response of another stimulus. When used successfully in conjunction with
      a therapeutic intervention, priming results in a behavior change coinciding with changes in
      neural processes. Motor priming exercises demonstrate changes in cortical excitability, or
      facilitate cognitive processing, thus inducing neuroplastic effects such as release of
      neurochemicals that may enhance the effect of subsequent training. Priming that target the
      motor cortex is a relatively new topic of research in the fields of motor control and
      rehabilitation

      This will be a randomized control trial and patients will be recruited through convenient
      sampling into three groups. Group A will be given functional electrical stimulations with
      motor priming exercises. Group B will be receiving functional electrical stimulations alone
      and group C will receive conventional exercises training. Pre and post measurements with
      outcome measuring tool will be taken. Tools for accessing tenodesis grip will be hand
      dynamometer, pinch meter, Manual Muscle Testing, graded redefined assessment of sensation ,
      strength and pretension; GRASSP tool, Spinal Cord Independence Measure SCIM- self care sub
      score . The data will be analyzed using SPSS 25 software.
    

Intervention name(s): Functional electrical stimulations and motor priming exercise; Functional electrical stimulations; Conventional physical therapy
Intervention type(s): Other; Other; Other
Intervention description(s): One pair of surface stimulation electrodes is placed on the subject's skin above the flexor digitorum superficialis and the flexor digitorum profundus muscles to generate finger flexion. The Second pair of electrodes is placed on the subject's skin, above the median
nerve, to generate thumb flexion. The third pair of electrodes is placed on the subject's skin, above the extensor digitorum muscle, to generate finger extension. Motor priming exercises will be done (functional task practice, FTP) for 20 minutes. Participants will be asked to spend at least 20 minutesDuration of training will be 4 weeks, 5 days per week, one session per day, and one hour per session.; Stimulation parameters are (1) balanced, biphasic, current-regulated electrical pulses; (2) pulse amplitude from 8 to 50 mA (typical values 17- 26 mA); (3) pulse width 250 ms; and (4) pulse frequency from 20 to 70 Hz (18). Trancutaneous stimulation will be delivered bilaterally with surface electrodes placed on the volar aspect of each wrist targeting the distribution of the median nerve. One pair of surface stimulation electrodes is placed on the subject's skin above the flexor digitorum superficialis and the flexor digitorum profundus muscles to generate finger flexion. The Second pair of electrodes is placed on the subject's skin, above the median
nerve, to generate thumb flexion for 20 minutes; a structured exercise protocol targeting strength (2 days/week) and endurance (3days/week) training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment