# PILOT STUDY OF COMBINED TRANSVERTEBRAL MAGNETIC AND TRANSCUTANEOUS STIMULATION FOR THE REHABILITATION OF COMBAT ACUTE SPINAL CORD INJURIES

## TL;DR

A pilot study combined magnetic and electrical stimulation to improve recovery in combat-related spinal cord injuries.

## Contribution

A novel non-invasive neurorehabilitation protocol combining rTvMS and TcES for acute spinal cord injury.

## Key findings

- Approximately 28% of patients improved functionally after three neurorehabilitation courses.
- Combining electromagnetic stimulation with physical movement enhanced spinal cord conduction.
- The 'end-to-end' stimulation approach showed neurological and functional improvements.

## Abstract

To improve the effectiveness of neurorehabilitation in patients with severe combat spinal cord injury by combining spinal cord repetitive transvertebral magnetic stimulation (rTvMS) and non-invasive transcutaneous electrical stimulation (TcES) of peripheral nerves.

For the best recovery from severe combat spinal cord injury, neurorehabilitation must start in the acute phase. Only technologies targeting sensorimotor conduction and functional improvement can confirm the potential of the time factor. Non-invasive neuromodulation has been shown to work for combat spinal cord injury of varying severity.

We have analysed 154 cases of severe combat spinal cord injury, followed continuously for at least 12 months from the start of neurorehabilitation. A unified «end-to-end» protocol combined rTvMS of the spinal cord with simultaneous TcES of peripheral nerves in different modes was developed for non-invasive spinal cord neuromodulation.

The combination of these parameters produced the most positive results in post-traumatic sensory-motor disorders: (i). rTvMS, level ThX-LI: 2000 pulses per set, 100 pulse packages, 5–10 Hz, intensity “+ 30––40%” of the threshold of the evoked motor potential; TcES n. tibialis or n. peroneus: 5–10 Hz, pulse intensity corresponded to the threshold of the motor response, functional electrical stimulation (FES) mode. (ii). rTvMS, level CII-ThII: 2000 pulses per set, 50 pulse packages, 5–7 Hz, intensity + 20–30% of the threshold of the evoked motor potential; TcES n. medianus or n. ulnaris; n. tibialis or n. peroneus: 5–10 Hz, pulse intensity corresponded to the threshold of the motor response, FES mode. Approximately 28% of patients in group A (FRANKEL/ASIA) moved to a higher level of function after 3 courses of neurorehabilitation intervention (90 working days).

Electro-magnetic stimulation of the spinal cord excitatory cell conduction system according to the principle of “end-to-end: as in Hebb’s theory,” combined with physical movement, led to an increase in spinal cord conduction in the acute phase of combat spinal cord injury. This was manifested by neurological and functional improvement.

If you imagine, for example, that the ability to move a person’s legs or arms depends on 2 nerve cells that are connected and form a kind of conductor or bridge, the ends of which are these cells, then any physical impact that breaks this contact will lead to the loss of this ability. Now, if we imagine that for every cell that has lost contact with another, we act in such a way that, under the influence of this action, they re-establish this connection; it is evident that this can lead to the restoration of movement. It is this «end-to-end» effect, that is simultaneously from both ends with electromagnetic waves of specific parameters on spinal cord cells above and below the level of damage, in combination with specific physical exercises, that led to the improvement of motor and sensory functions after severe gunshot spinal cord injury.