case_images: PMC11140104_01
case_images: MRI images and Radiographic before treatment. (A) Cervical magnetic resonance imaging showed C3-C7 cervical disk herniation associated with spinal stenosis that cause the spinal cord persistent oppression. (B) Postoperative radiograph. (C) Rehabilitation timeline chart. Assessments include ASIA, HAMA, HAMD, and SCIM-III.
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case_images: fig1
case_images: After admission, she was diagnosed with spinal stenosis and C3-C7 cervical disk herniation, which caused constant pressure on her spinal cord (Figure 1A). The posterior cervical C3-C6 region was internally stabilized with titanium plates for the unilateral open door approach, while lamina decompression was performed at the cervical C7 level (Figure 1B). In addition, in order to further optimize the therapeutic effects, the patient decided to undergo a combination therapy of Virtual Reality arm and leg cycling exercises combined with tSCS (Figure 1C). Figure S1A). Furthermore, a comparative analysis was performed on the SCIM-III scores during the period spanning from October 23, 2023 to December 04, 2023. In light of this, we examined the MRI and observed an amelioration in the compression of the spinal cord (Supplementary Figure S1B).
case_images: Patient undergoing Virtual Reality-based arm and leg cycling in therapy. (A) Real-world scenario: Virtual Reality-based limb-linkage rehabilitation training. (B) Virtual Reality glasses. (C) Virtual Scenario: Bicycle Race. (D) Virtual Scenario: time and weather. (E) Live chat in cycling. (F) Self-exercise goals for patient at different stages. (G) Real-time mileage ranking during the campaign. The above C-G images are from version 3.3.2 of the Dong Qi APP by Jinhua Zhanyue Intelligent Technology Company, China.
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case_images: fig2
case_images: Virtual reality-based arm and leg cycling started on the same day after completion of routine rehabilitation training (Figure 2A). TCL Mobile Communication Company, China) through a sensor connector (Figures 2B,C). The patient actively operated the device to facilitate synchronized movements of the upper and lower limbs, while character engaged in cycling activities on the simulated road (Figure 2D). There are several aspects to elucidate. Secondly, the therapist possesses the ability to independently regulate alterations in the virtual environment, including variations in time of day (sunrise, noon, and sunset) and weather conditions (sunny, cloudy, and snowy), which simulate changes in the cycling environment (Figure 2E). Additionally, the incorporation of supplementary virtual participants during the ride establishes a competitive environment, prompting the patient to engage in more extensive physical activity (Figure 2G). Patients are empowered to establish daily exercise objectives for themselves (Figure 2F) by leveraging the real-time feedback, individuals can strive toward achieving their exercise goals and ensure the fulfillment of their daily exercise routine.
case_images: Schematic diagram of electrode sheet position and electrode connection for tSCS.
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case_images: fig3
case_images: The stimulation waveform used biphasic, rectangular, 0.2 ms pulses at a frequency of 30 Hz, and the stimulation time was 30 min. The stimulation intensity was suitable for the patient to feel the microcurrent and no pain (60-80 mA) (Figure 3).
case_images: The changes of the patient's function. (A) The ASIA score (B) The upper and lower motor score. (C) The HAMA and HAMD score. (D) The SCIM-III score. The arrows represent the start of virtual reality-based arm and leg cycling combined with transcutaneous electrical spinal cord stimulation after completion of the assessment.
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case_images: PMC11140104_01_fnins-18-1380467-g004.jpg
case_images: fig4
case_images: The examination revealed a notable increase in motor scores, rising from 52 to 88, alongside a corresponding elevation in sensory scores, ascending from 139 to 169 (Figure 4A). Our analysis involved the separate calculation of motor scores for the upper and lower extremities, revealing superior improvement in the lower extremities (Figure 4B). Notably, as somatic functioning improved, there was a significant reduction in anxiety and depression levels (Figure 4C). The results obtained from the SCIM-III scale indicated a significant increase in scores, rising from 10 to 82, subsequent to the implementation of combination therapy (Figure 4D).