Combining neuromodulation strategies in spinal cord injury gait rehabilitation: A proof of concept, randomized, crossover trial

Kelly McKenzie, Nicole Veit, Shreya Aalla, Chen Yang, Matt Giffhorn, Alec Lynott, Kristine Buchler, Ameen Kishta, Alex Barry, Milap Sandhu, Yaejin Moon, William Zev Rymer, Arun Jayaraman

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhance task-specific training and lead to superior and more sustained gait improvements as compared to each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury (SCI).

DESIGN: Proof of concept, randomized crossover trial SETTING: Outpatient, rehabilitation hospital INTERVENTIONS: Ten participants completed 3 intervention arms: 1) AIH, tSCS, and gait training (AIH + tSCS), 2) tSCS plus gait training (SHAM AIH + tSCS), and 3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020 to January 4, 2023.

MAIN OUTCOME MEASURES: 10-meter walk test (10MWT) at self-selected velocity (SSV) and fast velocity (FV), 6-minute walk test (6MWT), Timed Up and Go (TUG) SECONDARY OUTCOME MEASURES: Isometric ankle plantarflexion and dorsiflexion torque RESULTS: TUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST) and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up. SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared to the other two arms at POST and 1WK for the 6MWT, FV, and ankle plantarflexion torque.

CONCLUSIONS: This pilot study is the first to demonstrate that combining these three neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete SCI and warrants further investigation.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
StateE-pub ahead of print - Jul 3 2024
Externally publishedYes


Dive into the research topics of 'Combining neuromodulation strategies in spinal cord injury gait rehabilitation: A proof of concept, randomized, crossover trial'. Together they form a unique fingerprint.

Cite this