Trunk Task-oriented Training Combined With Functional Electrical Stimulation in Spinal Cord Injured Individuals

Trunk Task-oriented Training Combined With Functional Electrical Stimulation in Spinal Cord Injured Individuals

Trunk Task-oriented Training Combined With Functional Electrical Stimulation to Improve Functional Independence, Postural Control and Neuroplasticity in Spinal Cord Injured Individuals

The objectives of the study are to evaluate trunk task-oriented training combined with function electrical stimulation (FES/T-TOT) efficacy on sitting balance and functional independence, and to understand the mechanisms of neuroplasticity that would improve functional independence following FES/T-TOT in individuals with spinal cord injury.

After obtaining their consent, participants will undertake evaluations at different times: Assessment 3 weeks prior to training Assessment 1 week prior to training Training over 12 weeks Assessment 1 week after training Assessment 1 month after training (follow-up) Each assessment will be divided in 2 sessions and data will be collected over 2 days, at one session per day. The assessment will consist of: Session 1 (at Neuro-Concept clinic) will include presentation of the study and the obtention of written consent, clinical (modified Reaching test and muscle strength), quality of life and functional independence assessments. Session 2 (at IURDPM in Dr. Barthélemy's laboratory) will include postural control, corticospinal and cortical assessments. After the initial assessment, the participants with spinal cord injury will realize 36 sessions of trunk task-oriented training alone or combined with function electrical stimulation (3 times a week for 12 weeks).

Trunk task-oriented training, Corticospinal tract, Functional electrical stimulation, Functional independence, Trunk motor control

This group will be formed with participants with spinal cord injury. This group will perform 12 weeks of trunk-oriented task training combined with functional electrical stimulation.

This group will be formed with participants with spinal cord injury. This group will perform 12 weeks of trunk-oriented task training.

Healthy participants will be recruited based on the age and sex of the participants with spinal cord injury to realize clinical, biomechanical and cortical evaluations

Training will consist to perform one hour of trunk task-oriented training combined with functional electrical stimulation (FES/T-TOT) specific for muscle strength and motor control. All training will be done seated without support with knees and hips flexed to 90 degrees. FES will be combined with functional and non-functional tasks to work functionality and muscle strengthening. Each training session will consist on the fulfilment of two functional tasks (as reaching) and two non-functional tasks (as push-up movement) from a battery of postural control exercises.

The SCI participants who will perform T-TOT training alone will have to perform the same exercises as explained in the previous section (two functional tasks and two non-functional tasks) but they will not receive any functional electrical stimulation. Training will consist to perform one hour of trunk task-oriented training (T-TOT) specific for muscle strength and motor control. All training will be done seated without support with knees and hips flexed to 90 degrees. Each training session will consist on the fulfilment of two functional tasks (as reaching) and two non-functional tasks (as push-up movement) from a battery of postural control exercises.

This test evaluates the sitting balance via 14 everyday functional activities rated from 0 to 4 according to the reactions of the participants.

This test evaluates the ability for each participant to realize a lateral and anterior trunk flexion in order to observe the maximum distance reached.

A tone will be triggered just before the reaching movement. The EMG responses of trunk muscles will be analyzed.

Modification of the excitability of the vestibulospinal pathway using galvanic vestibular stimulation

This interview will capture all physical activity information over the previous 3 days. Eight periods of day will be screened (morning routine, breakfast, morning, lunch, afternoon, dinner, evening, evening routine). This test allows us to verify if the intensity of daily physical activity of each participant will be constant during the intervention.

Change in quality of life using World Health Organization Quality of Life with disabilities module (WHOQOL-BREF)

The questionnaire consists in 36 questions about 8 domains: physical functioning, role functioning-physical, bodily pain, general health, vitality, social functioning, role functioning-emotional and mental health

This questionnaire consists in 37 questions about 4 domains: health and functioning, psychological/spiritual, social and economic, and family.

This questionnaire consists in evaluation of self-care, respiration and sphincter management, and a participant's mobility abilities.

FOR PARTICIPANTS WITH SPINAL CORD INJURY Inclusion Criteria: Level of spinal cord lesion between C6/C7 and T10 At least, 6 months post-injury Be considered as AIS A, B, C or D Be able to sit without support for 15 seconds Be able to provide informed consent in English or in French Exclusion Criteria: To have cognitive deficits To wear a corset To have personal or family history of epilepsy To have suffered moderate or severe traumatic brain injury To have cochlear implant FOR CONTROL PARTICIPANTS Exclusion Criteria: To have orthopedics problems To have cognitive deficits To have neurological problems