The objective of this study is to investigate the use of scTS combined with ABT in
inpatient rehabilitation, to facilitate UE functional recovery for individuals with acute
to subacute cervical SCI. The investigators will assess the safety, feasibility, and
preliminary efficacy of the combined intervention with a 10-day regimen in a randomized,
sham-controlled clinical trial. The investigators hypothesize that the combination of
scTS+ABT applied in individuals with acute to subacute cervical SCI will 1) be both safe
and feasible when implemented as a part of the medical care in an inpatient SCI
rehabilitation program, and 2) promote greater improvements in UE function compared to
sham control and ABT alone. In addition, the investigators will explore the potential
neurophysiological mechanism underlying the combined intervention by evaluating the
pre-post changes of cortical and spinal excitability. The investigators anticipate that
the functional outcome improvements will be associated with the gains of cortical and
spinal excitability.
(Aim 1) To determine whether scTS+ABT intervention is safe when applied to persons with
acute to subacute cervical SCI during inpatient rehabilitation. The investigators will
evaluate the intervention safety based on the adverse event reports focusing three
categories: (1) scTS-related (pain/discomfort and skin integrity), (2) ABT-related
(musculoskeletal injuries, heart rate, and oxygen saturation levels), and (3) SCI-related
(spasticity and autonomic dysreflexia). The type, frequency, and severity of adverse
events reported in scTS+ABT group will be compared to those from ABT alone group. (Aim 2)
To examine whether a 10-day regimen of scTS+ABT is feasible to apply to individuals with
acute to subacute SCI during an inpatient rehabilitation program. The interest and
willingness of participants to enroll and complete this study will provide insight into
the feasibility of scTS+ABT intervention. The investigators will assess the feasibility
based on quantitative data including ease of recruitment (accrual rate) and study
completion rate and compare the study completion rate in scTS+ABT and ABT alone group.
(Aim 3) To evaluate the efficacy of scTS+ABT intervention in promoting UE functional
recovery in acute to subacute SCI, as compared to the sham control and ABT only. Given
the greatest opportunity for recovery and neuroplasticity in acute-subacute SCI stage and
the promising results demonstrated in the previous chronic SCI studies, the investigators
expect that applying scTS+ABT at early stages would lead to greater UE function
improvements compared to scTSsham+ABT and ABT only. UE motor impairment, voluntary
handgrip strength, and UE functional ability will be quantitatively assessed three time
at baseline, once at the end of intervention, and once at 1-, 2-, 3-month follow up.
Within-group and between-group comparison will be made to evaluate the efficacy of
different interventions. (Aim 4, Exploratory) To quantify and characterize the
neurophysiological changes after scTS+ABT, as compared to the sham control or ABT alone.
Previous chronic studies have suggested that scTS can increase the excitability of spinal
network and activate the motor neurons within spinal cord distal to the lesion, leading
to restoration of voluntary motor control. Here, the investigators will examine whether a
10-day regimen of scTS+ABT applied in the acute to subacute stage can also lead to
neurophysiological gains. Pre-post changes in the cortical and spinal excitability will
be measured and compared to the sham control and ABT only group. As an exploratory aim,
the investigators will evaluated on a subset sample of each group (n=4).