'Royal College of Obstetricians & Gynaecologists (RCOG)'
Abstract
Transcutaneous spinal cord stimulation (TSCS) has been shown to improve motor recovery in people with spinal cord injury (SCI). Some groups deliver TSCS modulated with a kHz-frequency (TSCS–kHz); the intensity used for TSCS–kHz is usually set based on the motor threshold for TSCS, even though TSCS–kHz threshold is considerably higher than TSCS. As a result, TSCS–kHz interventions tend to be delivered at low intensities with respect to the motor threshold (~40%). In this study, we compared the effects of sub-threshold TSCS and TSCS–kHz, when delivered at similar intensity relative to their own motor threshold. Experiment I compared the after-effects of 20 min of sub-threshold (40% threshold) TSCS and TSCS–kHz on spinal and corticospinal excitability in able-bodied participants. Experiment II assessed the dose–response relationship of delivering short (10-pulse) trains of TSCS and TSCS–kHz at three different current intensities relative to the threshold (40%, 60%, and 80%). Experiment I found that 20 min of TSCS–kHz at a 40% threshold decreased posterior root reflex amplitude (p < 0.05), whereas TSCS did not. In experiment II, motor-evoked potential (MEP) amplitude increased following short trains of TSCS and TSCS–kHz of increasing intensity. MEP amplitude was significantly greater for TSCS–kHz compared with TSCS when delivered at 80% of the threshold (p < 0.05). These results suggest that TSCS and TSCS–kHz have different effects when delivered at similar intensity relative to their own threshold; both for immediate effects on corticospinal excitability and following prolonged stimulation on spinal excitability. These different effects may be utilized for optimal rehabilitation in people with SCI
