253 Spinal Cord Stimulation Combined With Rehabilitation Improves Motor Function and Functional Connectivity in Spinal Cord Injury Patients

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INTRODUCTION: Electrical spinal cord stimulation (SCS) has emerged as a potential therapy for restoring motor paralysis after spinal cord injury (SCI). Its mechanism of action is based on the recruitment of proprioceptive fibers linked through excitatory synapses to motoneurons at the level of the target root. However, the hypothesis that SCS, aided by motor rehabilitation, may also play a role in neuroplasticity is growing. METHODS: Three SCI patients unable to walk and stand, and classified according to the American spinal injury association impairment scale (AIS) as C (motor and sensory incomplete), were implanted with a SCS system within a clinical trial aiming at investigating the effects of SCS with locomotor training on the recovery of motor function. Along the protocol, brain fMRI including a motor-task (think about making foot anti-phase movements) was carried out before surgery and 6 months later. Functional connectivity changes over time within subjects were assessed. RESULTS: All patients achieved significant motor improvement, progressing from being unable to stand or walk to being able to stand and walk overground independently with the assistance of a walker. Single patient motor-task fMRI comparison between baseline and 6-month showed widespread increased brain activity of medial sensorimotor areas and supplementary motor area in all three patients. At correlation analysis, the improvement of motor metrics over time (Medical Research Council muscle power scale, 10 meters walking test and 6 minutes walking test) were related to the increased sensorimotor areas functional activity over time (p<0.01). CONCLUSIONS: In SCI patients, SCS combined with neurorehabilitation supports motor improvement and brain functional reorganization, promoting the functional plasticity of brain areas involved in motor processes and executive abilities.

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