Driving neuroplasticity and gait recovery with transcranial direct stimulation in incomplete spinal cord injury: a pilot study

The central hypothesis is that anodal transcranial direct current stimulation to the lower extremity cortical area paired with robot-assisted treadmill training (Lokomat) will improve lower extremity motor function more than motor training alone in subjects with incomplete SCI. According to the National Spinal Cord Injury Statistical Center, as many as 300,000 people in the United States are living with spinal cord injury (SCI). Every year, there are approximately 12,000 new cases of SCI in the United States. Less than 1% of those with SCI will experience complete recovery, highlighting the need for effective therapeutic interventions after neurologic damage has occurred. A common theme in the recovery literature is that specific and intensive motor training induces adaptive neurological reorganization, also known as plastic change. Additionally, persistent responsiveness to sensory and motor input, and the plastic changes that result, can occur after incomplete SCI because the spinal cord remains partially preserved and interconnected with the intact brain. This suggests that interventions shown successful in stroke may also be effective in incomplete spinal cord injury. Furthermore, several lines of evidence indicate that a non-invasive form of brain stimulation called transcranial direct current stimulation (tDCS) facilitates motor recovery after stroke. However, there is no available data about the extent to which this non-invasive stimulation will enhance motor training for the legs in patients with incomplete spinal cord injury. Here, we propose a novel pilot project to evaluate the effectiveness of tDCS delivered before leg motor training, to promote functional motor recovery in patients with incomplete spinal cord injury. The central hypothesis is that patients with incomplete spinal cord injury receiving tDCS prior to treadmill training will have improved motor function compared to those who receive sham tDCS and treadmill training. The long-range goals are to: (a) maximize the restoration of leg motor function in patients with incomplete spinal cord injury, (b) determine the impact of this intervention on activities of daily living and quality of life, and (c) collect preliminary data in preparation for a future, large-scale, federally funded study.