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Review
. 2023 May 29;9(1):11.
doi: 10.1186/s42234-023-00113-6.

Neuromodulation for recovery of trunk and sitting functions following spinal cord injury: a comprehensive review of the literature

Niraj Singh Tharu  1 , Arnold Yu Lok Wong  2   3 , Yong-Ping Zheng  4   5
Affiliations
Review

Neuromodulation for recovery of trunk and sitting functions following spinal cord injury: a comprehensive review of the literature

Niraj Singh Tharu et al. Bioelectron Med. .

Erratum in

Abstract

Trunk stability is crucial for people with trunk paralysis resulting from spinal cord injuries (SCI), as it plays a significant role in performing daily life activities and preventing from fall-related accidents. Traditional therapy used assistive methods or seating modifications to provide passive assistance while restricting their daily functionality. The recent emergence of neuromodulation techniques has been reported as an alternative therapy that could improve trunk and sitting functions following SCI. The aim of this review was to provide a broad perspective on the existing studies using neuromodulation techniques and identify their potentials in terms of trunk recovery for people with SCI. Five databases were searched (PubMed, Embase, Science Direct, Medline-Ovid, and Web of Science) from inception to December 31, 2022 to identify relevant studies. A total of 21 studies, involving 117 participants with SCI, were included in this review. According to these studies, neuromodulation significantly improved the reaching ability, restored trunk stability and seated posture, increased sitting balance, as well as elevated activity of trunk and back muscles, which were considered early predictors of trunk recovery after SCI. However, there is limited evidence regarding neuromodulation techniques on the improvement of trunk and sitting functions. Therefore, future large-scale randomized controlled trials are warranted to validate these preliminary findings.

Keywords: Neuromodulation; Rehabilitation; Sitting balance; Spinal cord injury; Trunk stability.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Five forms of neuromodulation therapies (A) FES, (B) ES, (C) FNS, (D) TSCS, and (E) EES, described in this review. Electrodes placement: FES implanted in thoraco-lumbar region, ES transcutaneously over abdominal muscles, FNS implanted in thoracic region, TSCS transcutaneously over spinal cord in thoraco-lumbar region, and EES implanted in dorsal epidural surface in lumbosacral spinal cord enlargement. Abbreviation: FES = functional electrical stimulation; ES = electrical stimulation; FNS = functional neuromuscular stimulation; TSCS = transcutaneous electrical spinal cord stimulation; EES = epidural spinal electrical stimulation
Fig. 2
Fig. 2
Flow diagram of the article selection process
Fig. 3
Fig. 3
(A) Publication trends for FES (n = 5), ES (n = 5), FNS (n = 5), TSCS (n = 3), and EES (n = 3) by year; and (B) reported study designs of each neuromodulation technique with number of articles published. Abbreviation: FES = functional electrical stimulation; ES = electrical stimulation; FNS = functional neuromuscular stimulation; TSCS = transcutaneous electrical spinal cord stimulation; EES = epidural spinal electrical stimulation; RCT = randomized controlled trial
Fig. 4
Fig. 4
For specific neuromodulation techniques: (A) participants gender classification; and (B) participants AIS scores. Abbreviation: FES = functional electrical stimulation; ES = electrical stimulation; FNS = functional neuromuscular stimulation; TSCS = transcutaneous electrical spinal cord stimulation; EES = epidural spinal electrical stimulation; AIS = American Spinal Injury Association Impairment Scale
See this image and copyright information in PMC

References

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