Improve Dynamic Lateral Balance of Humans With SCI

A major goal of patients with spinal cord injury (SCI) is to regain walking ability, as
limitations in mobility can affect most activities of daily living. In addition, patients
with SCI may experience a higher incidence of falls due to impaired balance and gait. Dynamic
balance control plays a crucial role during locomotion in human SCI. Thus, improved dynamic
balance may facilitate locomotion in this population. Current balance training paradigms can
be effective in improving balance during standing, but are less effective in improving
dynamic balance during locomotion in humans with SCI. Thus, there is a need to develop new
paradigms for improving dynamic balance and locomotor function in patients with SCI. The goal
of this study is to test whether pelvis perturbation training paired with transcutaneous
spinal direct current stimulation (tsDCS) will be effective in improving dynamic balance and
locomotor function in humans with SCI. We postulate that providing a perturbation force to
the pelvis during treadmill training will increase the activation of muscles used for
maintaining lateral balance while walking. Further, repeated activation of particular
sensorimotor pathways may reinforce circuits and synapses used for lateral balance control
through a use-dependent neural plasticity mechanism. However, the excitability of spinal cord
neural circuitries may be depressed due to the reduced descending drive signals from the
upper level control center after SCI, which may reduce the efficacy of neuralplastic changes
achieved following rehabilitation. The excitability of neural pathways is crucial for neural
reorganization achieved following rehabilitation. Recently studies indicate that tsDCS may
modulate the excitability of neural circuitries of the spinal cord in patients with SCI.
Thus, we postulate that controlled pelvis perturbation training paired with tsDCS will be
more effective than that paired with a sham in improving dynamic balance and locomotor
function in humans with SCI. Results obtained from this study will lead to an innovative
clinical therapy aimed at improving balance and walking function in humans with SCI.
Improvements in balance and walking function may allow for increased participation in
community-based ambulation and activities, and significantly improve quality of life in
humans with SCI.

Inclusion Criteria:

1. age between 18 and 65 years;

2. medically stable with medical clearance to participate;

3. level of the SCI lesion between C4-T10;

4. passive range of motion of the legs within functional limits of ambulation;

5. ability to walk on a treadmill for more than 20 minutes with partial body weight
support as needed and short sitting/standing breaks;

6. ability to ambulate without orthotics or with orthotics that do not cross the knee for
more than 10 meters

Exclusion Criteria:

1. the presence of unhealed decubiti, existing infection, severe cardiovascular and
pulmonary disease, concomitant central or peripheral neurological injury (e.g.
traumatic head injury or peripheral nerve damage in lower limbs);

2. history of recurrent fractures and/or known orthopedic injury to the lower
extremities;

3. Botox injection within 6 months of starting the study, and current receiving physical
therapy treatment;

4. have metallic implantation in the spinal region underneath where electrodes may be
placed.