case_images: PMC7323764_01
case_images: (A) Initial evaluation with CT cross-section at injury level (1); the sagittal MRI view of the thoracic spine with the area of SCI; (3) X-ray view of the spine fixation structure; (4) 3D reconstruction of vertebras with areas of laminectomy and spine fixation structure, circles indicate position of the ultrasound sensor in the projection of laminectomy; (5) three transverse MRI sections of the spinal cord at the injury level (T1 weighted lesion); (6) visualization of the spinal cord at injury level with ultrasound technique. (B) Study design with approach of SCI evaluation in human. Assessment of SEMP (I) with the role of injury type (a) and electrode position (b); the influence of supraspinal and afferent information (II) tested with reinforcement maneuvers (a) and positional changes (b); and the role of motor rehabilitation (III). (C) Timeline of the study. (D) An example of somatosensory evoked potentials (SSEP) recorded with stimulation of the n. Tibialis with recording electrodes located at the Cz-Fpz, Th8-9, Th11-12, L2-3, and popliteal region. Average of 800 responses presented for each location. Gray circles indicate the SSEP at the Th11-12, L2-3, and popliteal region. (E) SSEP amplitude at popliteal region, L2-3, and Th11-12 level during stimulation on the right and left n. Tibialis (n = 3).
case_images: fnins-14-00552-g001.jpg
case_images: PMC7323764_01_fnins-14-00552-g001.jpg
case_images: F1
case_images: Urgently, she underwent hepatorrhaphy, and 5 days after injury, the decompression spine surgery at the level Th12, followed by reduction spondylodesis Th11-L1 (Figures 1A-1,2,3). A computed tomography scan (CT) was performed before surgery and magnetic resonance imaging (MRI) was captured post-surgery, although, some distortion was apparent due to spinal fixation hardware (Figures 1A-2,5). Additionally, injury site was assessed with ultrasound (Figure 1A-6). Figure 1B summarizes tested in this report electrophysiological assessment: (I) examination of spinally evoked motor potentials (SEMP) to transcutaneous stimulation (tSCS) applied at Th9-10, Th10-11, Th11-12, Th12-L1, L1-2 levels; (II) the evaluation of the supraspinal influence and afferent signaling by assessment the effect of reinforcement maneuver (Jendrassik maneuver, JM) and positional changes. During the initial electrophysiological assessment, the subject with SCI was evaluated with techniques I and II (Figures 1B,C). After the initial assessment 65 rehabilitation sessions, approximately 45 min each, consisting of trainer-assisted standing and weight supported stepping were performed over 16 weeks, with the following electrophysiological assessment (Figure 1C; see Supplementary Material).
case_images: (A) Examples of SEMP recorded from proximal (RF) and distal (TA) muscles during stimulation at Th9-10, Th10-11, Th11-12, Th12-L1, and L1-2 levels, in supine position. (B) Changes in the thresholds, maximal amplitudes, and the latency of the SEMP recorded from proximal (RF and MH) and distal (TA, SOL) muscles with stimulation applied at Th9-10, Th10-11, Th11-12, Th12-L1, and L1-2 levels. (C) Examples of the SEMP recorded from RF, MH, TA, and SOL with paired pulses stimulation (interstim interval of 50 ms) at Th11-12 level. Black arrow indicate the moment of the stim. (D) The amplitudes of the SEMP recorded from right and left side during paired stimulation at Th11-12 level. (E) Examples of M wave and H-reflex recorded form SOL muscle at stimulation intensity varied from 8 to 25 mA with increment of 1 mA. Recruitment curves of the M wave (black line) and the H-reflex (light gray line) presented on the right. (F) The amplitudes (%) of the H-reflex recorded from right and left side (n = 10) during performance of Jendrassik maneuver (gray bars). Dotted lines indicate the control values of the H-reflex (100%). (G) Examples of the SEMP recorded from RF and TA during stimulation at Th12-L1 without (black line) and with Jendrassik maneuver (gray line) in supine and in upright (less than 30% body weight support) positions. Gray circles indicate the facilitation of the SEMP bilaterally RF, and in left TA by Jendrassik maneuver. (H) The amplitudes (%) of the SEMP recorded from right and left proximal (RF and MH) and distal muscles (TA and SOL) with stimulation at Th12-L1 during performance of Jendrassik maneuver in supine (light gray) and upright (less than 30% body weight support) positions (dark gray) in subject with SCI (n = 4). Dotted lines indicate the control values of the SEMP (100%). Difference marked with an asterisk indicates significance (*p < 0.05).
case_images: fnins-14-00552-g002.jpg
case_images: PMC7323764_01_fnins-14-00552-g002.jpg
case_images: F2
case_images: Urgently, she underwent hepatorrhaphy, and 5 days after injury, the decompression spine surgery at the level Th12, followed by reduction spondylodesis Th11-L1 (Figures 1A-1,2,3). A computed tomography scan (CT) was performed before surgery and magnetic resonance imaging (MRI) was captured post-surgery, although, some distortion was apparent due to spinal fixation hardware (Figures 1A-2,5). Additionally, injury site was assessed with ultrasound (Figure 1A-6).
case_images: (A) Examples of the SEMP recorded from TA muscle during stimulation at Th11-12 level in supine and upright (less than 30% body weight support) positions after the first verticalization before (gray lines) and after rehabilitation therapy (black lines). (B) The thresholds of the SEMP recorded in supine (gray lines) and upright (less than 30% body weight support) position after the first verticalization (black lines) in TA, SOL, RF, and MH (n = 6). (C) Changes in amplitude and threshold of SEMP recorded from RF, MH, TA, and SOL in supine position before (gray) and after (black) rehabilitation therapy (n = 4). (D) Example of the SEMP recorded from TA during stimulation at Th11-12 level in upright position (less than 30% body weight support) before (gray line) and after rehabilitation therapy (black line). The black and gray numbers indicate the number of polysynaptic components of the SEMP. Histograms and cumulative percentage of latencies (ms) of polysynaptic components of the SEMP recorded from TA before and after rehabilitation. Counts - frequency of occurrence of latencies of LR in interval of 1 ms. Cumulative percent - cumulative percentage of frequency of occurrence of latencies of LR in interval of 1 ms. Difference marked with an asterisk indicates significance (*p < 0.05).
case_images: fnins-14-00552-g003.jpg
case_images: PMC7323764_01_fnins-14-00552-g003.jpg
case_images: F3
case_images: Urgently, she underwent hepatorrhaphy, and 5 days after injury, the decompression spine surgery at the level Th12, followed by reduction spondylodesis Th11-L1 (Figures 1A-1,2,3). A computed tomography scan (CT) was performed before surgery and magnetic resonance imaging (MRI) was captured post-surgery, although, some distortion was apparent due to spinal fixation hardware (Figures 1A-2,5). Additionally, injury site was assessed with ultrasound (Figure 1A-6).