Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage
Abstract Background There is growing interest in use of transcutaneous spinal stimulation (TSS) for people with neurologic conditions both to augment volitional control (by facilitating motoneuron excitability), and to decrease spasticity (by activating inhibitory networks). Various electrode montag...
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| Language: | English |
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BMC
2025-01-01
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| Series: | Journal of NeuroEngineering and Rehabilitation |
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| Online Access: | https://doi.org/10.1186/s12984-024-01524-5 |
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| author | Kelly Lynn Thatcher Karen Emily Nielsen Evan Blake Sandler Oliver John Daliet Jennifer Ann Iddings Edelle Carmen Field-Fote |
| author_facet | Kelly Lynn Thatcher Karen Emily Nielsen Evan Blake Sandler Oliver John Daliet Jennifer Ann Iddings Edelle Carmen Field-Fote |
| author_sort | Kelly Lynn Thatcher |
| collection | DOAJ |
| description | Abstract Background There is growing interest in use of transcutaneous spinal stimulation (TSS) for people with neurologic conditions both to augment volitional control (by facilitating motoneuron excitability), and to decrease spasticity (by activating inhibitory networks). Various electrode montages are used during TSS, with little understanding of how electrode position influences spinal circuit activation. We sought to identify the thoracolumbar electrode montage associated with the most robust activation of spinal circuits by comparing posterior root-muscle reflexes (PRM reflexes) elicited by 6 montages. Additionally, we assessed tolerability of the stimulation during PRM reflex testing. Methods Fifteen adults with intact neurological systems participated in this randomized crossover study. PRM reflexes were evoked transcutaneously using electrode montages with dorsal–ventral (DV) or dorsal-midline (DM) current flow. DV montages included: [1] cathode over T11/T12, anodes over iliac crests (DV-I), [2] cathode over T11/T12, anodes over umbilicus (DV-U), [3] dual paraspinal cathodes at T11/12, anodes over iliac crests (DV-PI), and [4] dual paraspinal cathodes at T11/12, anodes over umbilicus (DV-PU). DM montages included: [5] cathode over T11/12, anode 5 cm caudal (DM-C), and [6] cathode over T11/12, anode 5 cm rostral (DM-R). PRM reflex recruitment curves were obtained in the soleus muscle of both lower extremities. Results Lower reflex thresholds (mA) for dominant (D) and nondominant (ND) soleus muscles were elicited in DV-U (D: 46.7[33.9, 59.4], ND: 45.4[32.5, 58.2]) and DV-I (D: 48.1[35.3, 60.8], ND: 45.4[32.5, 58.2]) montages compared to DV-PU (D: 64.3[51.4, 77.1], ND:61.7[48.8, 74.6]), DV-PI (D:64.9[52.1, 77.7], ND:61.4[48.5, 75.5]), DM-C(D:60.0[46.9, 73.1], ND:63.6[50.8, 76.5]), and DM-R(D:63.1[50.3, 76.0], ND:62.6[49.8, 75.5]). DV-U and DV-I montages demonstrated larger recruitment curve area than other montages. There were no differences in response amplitude at 120% of RT(1.2xRT) or tolerability among montages. Conclusions Differences in spinal circuit recruitment are reflected in the response amplitude of the PRM reflexes. DV-I and DV-U montages were associated with lower reflex thresholds, indicating that motor responses can be evoked with lower stimulation intensity. DV-I and DV-U montages therefore have the potential for lower and more tolerable interventional stimulation intensities. Our findings optimize electrode placement for interventional TSS and PRM reflex assessments. Clinical Trial Number: NCT04243044. |
| format | Article |
| id | doaj-art-108413e4d1d642e3a0679adce70a4526 |
| institution | Kabale University |
| issn | 1743-0003 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of NeuroEngineering and Rehabilitation |
| spelling | doaj-art-108413e4d1d642e3a0679adce70a45262025-01-12T12:10:38ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032025-01-0122111210.1186/s12984-024-01524-5Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montageKelly Lynn Thatcher0Karen Emily Nielsen1Evan Blake Sandler2Oliver John Daliet3Jennifer Ann Iddings4Edelle Carmen Field-Fote5Hulse Spinal Cord Injury Research Lab, Shepherd CenterDepartment of Population Health Sciences, Georgia State UniversityHulse Spinal Cord Injury Research Lab, Shepherd CenterHulse Spinal Cord Injury Research Lab, Shepherd CenterHulse Spinal Cord Injury Research Lab, Shepherd CenterHulse Spinal Cord Injury Research Lab, Shepherd CenterAbstract Background There is growing interest in use of transcutaneous spinal stimulation (TSS) for people with neurologic conditions both to augment volitional control (by facilitating motoneuron excitability), and to decrease spasticity (by activating inhibitory networks). Various electrode montages are used during TSS, with little understanding of how electrode position influences spinal circuit activation. We sought to identify the thoracolumbar electrode montage associated with the most robust activation of spinal circuits by comparing posterior root-muscle reflexes (PRM reflexes) elicited by 6 montages. Additionally, we assessed tolerability of the stimulation during PRM reflex testing. Methods Fifteen adults with intact neurological systems participated in this randomized crossover study. PRM reflexes were evoked transcutaneously using electrode montages with dorsal–ventral (DV) or dorsal-midline (DM) current flow. DV montages included: [1] cathode over T11/T12, anodes over iliac crests (DV-I), [2] cathode over T11/T12, anodes over umbilicus (DV-U), [3] dual paraspinal cathodes at T11/12, anodes over iliac crests (DV-PI), and [4] dual paraspinal cathodes at T11/12, anodes over umbilicus (DV-PU). DM montages included: [5] cathode over T11/12, anode 5 cm caudal (DM-C), and [6] cathode over T11/12, anode 5 cm rostral (DM-R). PRM reflex recruitment curves were obtained in the soleus muscle of both lower extremities. Results Lower reflex thresholds (mA) for dominant (D) and nondominant (ND) soleus muscles were elicited in DV-U (D: 46.7[33.9, 59.4], ND: 45.4[32.5, 58.2]) and DV-I (D: 48.1[35.3, 60.8], ND: 45.4[32.5, 58.2]) montages compared to DV-PU (D: 64.3[51.4, 77.1], ND:61.7[48.8, 74.6]), DV-PI (D:64.9[52.1, 77.7], ND:61.4[48.5, 75.5]), DM-C(D:60.0[46.9, 73.1], ND:63.6[50.8, 76.5]), and DM-R(D:63.1[50.3, 76.0], ND:62.6[49.8, 75.5]). DV-U and DV-I montages demonstrated larger recruitment curve area than other montages. There were no differences in response amplitude at 120% of RT(1.2xRT) or tolerability among montages. Conclusions Differences in spinal circuit recruitment are reflected in the response amplitude of the PRM reflexes. DV-I and DV-U montages were associated with lower reflex thresholds, indicating that motor responses can be evoked with lower stimulation intensity. DV-I and DV-U montages therefore have the potential for lower and more tolerable interventional stimulation intensities. Our findings optimize electrode placement for interventional TSS and PRM reflex assessments. Clinical Trial Number: NCT04243044.https://doi.org/10.1186/s12984-024-01524-5NeuromodulationTranscutaneous spinal stimulationSpinal excitabilityElectrodes |
| spellingShingle | Kelly Lynn Thatcher Karen Emily Nielsen Evan Blake Sandler Oliver John Daliet Jennifer Ann Iddings Edelle Carmen Field-Fote Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage Journal of NeuroEngineering and Rehabilitation Neuromodulation Transcutaneous spinal stimulation Spinal excitability Electrodes |
| title | Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage |
| title_full | Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage |
| title_fullStr | Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage |
| title_full_unstemmed | Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage |
| title_short | Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage |
| title_sort | optimizing transcutaneous spinal stimulation excitability of evoked spinal reflexes is dependent on electrode montage |
| topic | Neuromodulation Transcutaneous spinal stimulation Spinal excitability Electrodes |
| url | https://doi.org/10.1186/s12984-024-01524-5 |
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