Researchers have, for the first time, shown that synchronising electrical and magnetic stimulation therapy, otherwise known as paired associative stimulation therapy (PAS), can improve a paraplegic patient’s ability to walk.
Researchers at the BioMag Laboratory, operated by the University of Helsinki, Helsinki University Hospital and Aalto University, have previously found that stimulating the motor nerves of the brain and limbs can be useful for motor rehab in patients with spinal cord injuries by strengthening neural connections and, in turn, restoring patients’ mobility.
In 2016, researchers showed that applying a modified version of the original PAS to two spinal cord injury patients can enhance motor output of paretic muscles and return movement to such paralysed muscles.
The researchers then modified PAS to a version that uses high intensity transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). They found that this version could help patients with paralysis of all four limbs regain motor function.
Now, researchers at the lab have demonstrated the potential of PAS in treating incomplete paraplegia, and how it can help patients to walk again when combined with walking rehab.
The case study, newly published in the Spinal Cord Series and Cases journal, involved a spinal cord injury patient who regained the ability to walk independently with the help of a rolling walker.
It’s the first time researchers applied the new PAS developed by the research group to a paraplegic patient and successfully enabled and promoted walking rehabilitation in a patient who was initially not able to walk without assistance.
Anastasia Shulga, lead researcher on the case study and neuroscientist and medical doctor from the University of Helsinki, says this demonstrates for the first time that paired associative stimulation helped a paraplegic patient walk.
“Stimulation therapy has already previously been found to be a potential mode of treatment for spinal cord injuries. These findings spur us on to continue investigating paired associative stimulation.”
The 47-year-old patient, whose lower limbs were partially paralysed due to a spinal cord injury, was given stimulation therapy. He couldn’t stand up without considerable body weight support, and conventional walking rehab was seen as pointless.
A year after his injury, his left leg, which had only partially recovered, received stimulation treatment for three months. This was then repeated the following year.
After the first three-month stimulation treatment, he was able to stand for one-and-a-half minutes and take 13 steps on parallel bars without weight support. He was then enrolled into walking rehab, during which he was able to walk independently with the help of a rollator.
During the second three-month treatment period, his walking distance grew two-and-a-half times faster compared to the previous period when he received no stimulation.
“One year on from the trauma, the speed of recovery slows down markedly and there is little spontaneous recovery,” Shulga says.
New therapies are needed for treating traumatic spinal cord injuries, Shulga says, since the only method currently in clinical use, other than rehab, is the surgical stabilisation of the spine. She is continuing to research the new, modified PAS.
“PAS consists of TMS and PNS,” she tells NR Times. “PNS equipment has been widely available in hospitals around the world for decades, and TMS is getting more and more popular, well-known and available, as it’s used for treatment of many other conditions, such as depression and chronic pain. TMS is also utilised in pre-operative diagnostics.
“Our approach doesn’t require any new devices, but is rather a new way to utilise the devices that already exist. This makes our approach feasible and open for collaboration, wide utilization and further development around the world,” she says.
